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RC311  .F642  Consumption  a  curabi 


RECAP 


3T  TUBERCULOSIS  i 


: 


PTION 


A  CURABLE  AND,PREVENTaBLE 

.".^^!  DISEASE     ^ 


LAWRENCE  F.  FLICK  M.D. 


PRICE  |lXDO  NET 


Columbia  ®nibersiitp 

in  rte  Citp  of  i?eto  gorfe 

COLLEGE  OF  PHYSICIANS 
AND   SURGEONS 


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The  Crusade  Against  Tuberculosis 

Consumption  a  Curable 
and  Preventable  Disease 

What  a  Layman  Should  Know  About  It 


LAWRENCE  F.   FLICK,   M.D. 

Founder  of  the  Pennsylvania  Society  for  the  Prevention  of  Tuber- 
culosis;  President  of  the  Free  Hospital  for  Poor  Consump- 
tives of  Pennsylvania ;    Medical  Director  of  the 
Henry  Phipps  Institute  for  the  Study, 
-    Treatment,  and  Prevention 
of  Tuberculosis 


PHILADELPHIA 
DAVID   McKAY,  Publisher 

I022    MARKET    STREET 
1903 


Copyright,    1903,  by  David  McKay 


WM.  F.   FELL  COMPANY 

CLECTROTYPERS  AND   PRINTERS 
PHILADELPHIA 


WITH    ESTEEM    AND    AFFECTION    THIS    LITTLE    VOLUMF. 
IS    DEDICATED    TO 

HENRY  PHIPPS,   ESQ., 

WHO    BY    HIS    GENEROSITY    AND    INTEREST    HAS 

LAUNCHED    THE    CRUSADE    AGAINST    TUBERCULOSIS    ON 

BROAD    OPEN    WATERS. 


CONTENTS 

PAGE 

Introduction,     . 9 

What  Consumption  is, I5 

What  Tuberculosis  is, 21 

The  Relationship  between  Consumption  and  Tuber- 
culosis,      2^ 

What  Colds,  Influenza,  and  Pneumonia  have  to  do 

with  Consumption, 3^ 

What  Consumption  Means  to  the  World, 37 

The  Prevalency  of  Tuberculosis, 43 

How  Consumption  Came  into  the  World,    ....  48 

Is  Consumption  Inherited  ? 55 

Predisposition  to  Consumption, 62 

Diseases  which  Predispose  to  Consumption,     ...  68 
Dissipation  as  a  Predisposing  Cause  of  Consump- 
tion,       74 

Want  as  a  Predisposing  Cause  of  Consumption,  .    .  80 

Overwork  as  a  Predisposing  Cause  of  Consumption,  85 

Alcohol  as  a  Predisposing  Cause  of  Consumption,  .  90 

Climate  as  a  Factor  in  Consumption, 95 

Immunity  from  Tuberculosis, lOO 

Tuberculosis  is  Contagious, lo^ 

How  Tuberculosis  is  Spread  by  Contact  with  the 

Consumptive,      ^^" 

Consumption  is  a  House  Disease, 123 

The  Workshop  in  the  Spread  of  Tuberculosis,     .    .  128 

The  Store  in  the  Spread  of  Tuberculosis,     ....  133 

The  Office  in  the  Spread  of  Tuberculosis,    ....  138 
Hotels    and    Boarding-houses   in    the    Spread    of 

Tuberculosis, '43 

7 


8  Contents 

PAGE 

The  Spread  of  Tuberculosis  by  Consumptive  Ser- 
vants,    148 

The  School-room  in  the  Spread  of  Tuberculosis,  .   .  153 
Churches  and  Public  Halls  in  the  Spread  of  Tuber- 
culosis,   158 

Public  Conveyances  in  the  Spread  of  Tuberculosis,  163 

The  Chances  of  Getting  Tuberculosis  on  the  Street,  1 68 
Are   Human   and  Animal   Tuberculosis  the  Same 

Disease? 174 

Tuberculosis  from  Meat  and  Milk, 18 1 

How  the  Tubercle  Bacillus  Gets  into  the  System,  .  187 

The  Natural  Course  of  Tuberculosis, 1 96 

Tuberculosis  is  a  Curable  Disease, 203 

The  Treatment  of  Consumption,    ........  209 

Food  in  the  Treatment  of  Consumption, 214 

Fresh  Air  in  the  Treatment  of  Consumption,  .    .    .  223 

Rest  and  Exercise  in  the  Treatment  of  Consumption,  230 

How  Long  it  Takes  for  Consumption  to  Get  Well,  235 

The  Prevention  of  the  Spread  of  Tuberculosis,    .    .  243 
The  Consumptive  Can  Avoid  Giving  His  Disease 

to  Others, 250 

The  Government  in  the  Prevention  of  Tuberculosis,  259 
How  to  Sterilize  Places  and  Things  Which  Have 

Been  Contaminated  by  Consumptives,    ....  266 
Dispensaries,    Hospitals,  and   Sanatoria   for   Con- 
sumptives,    272 

How  to  Avoid  Getting  Consumption, 278 

Should  Consumptives   Marry? 286 

Should  a  Consumptive  Mother  Suckle  her  Child  ?  291 


INTRODUCTION 

WHEN  Pasteur  gave  the  world  his  great 
discovery  that  fermentation  is  due  to  life, 
he  blazed  the  way  for  exact  knowledge 
about  disease  which  since  has  been  pursued 
with  great  success.  From  the  knowledge 
that  fermentation  was  due  to  a  living  organ- 
ism to  the  theory  that  disease  was  due  to  a 
living  organism  was  but  a  step — and  a  step 
easily  taken,  inasmuch  as  some  men  had 
already  suspected  that  disease  was  but  an 
episode  in  organic  nature.  Well-directed 
research  soon  displaced  theory  with  fact. 

Pasteur  himself  was  the  first  to  extend 
his  discovery  into  the  domain  of  disease  by 
demonstrating  that  disease  which  affected 
wine  was  due  to  the  parasitic  life  of  minute 
organisms  so  small  as  to  require  a  power- 
ful lens  to  reveal  them  to  the  naked  eye. 
Next,   he  v/as  able  to   show  that   disease 

9 


I  o  Introduction 

which  destroyed  the  silk  worm  was  like- 
wise due  to  the  parasitic  life  of  micro- 
organisms, as  such  minute  living  things 
came  to  be  called.  Other  laborers  entered 
the  field,  and  one  by  one  diseases  yielded 
up  their  secrets. 

We  now  know  the  definite  cause  of 
many  diseases,  each  a  microscopic  organ- 
ism endowed  with  life  and  the  essential 
qualities  of  all  living  things.  These  are 
birth,  growth,  reproduction,  and  death. 
Of  some  diseases  the  cause  still  lies  hid- 
den. We  have  not  yet  been  able  to  bring 
to  light  the  organisms  which  produce  them 
although  by  analogy  we  have  good  reason 
to  believe  that  such  organisms  exist.  In 
time  we  will  know  all. 

The  new  knowledge  about  disease  which 
has  come  into  the  world  is  destined  to 
revolutionize  everything.  The  microscope 
is  making  us  acquainted  with  a  kingdom  in 
nature  which  we  did  not  dream  of  before, 
and  which  is  as  important  for  the  mainten- 


Introduction  1 1 


ance  of  the  existing  state  of  things  as  are 
the  animal  and  vegetable  kingdoms. 

This  kingdom  is  a  veritable  fairy  land. 
Its  inhabitants  are  more  numerous  than 
the  sands  of  the  sea,  and  as  varying  in 
their  functions  as  are  the  inhabitants  of  the 
animal  and  vegetable  kingdoms.  They  are 
all  so  minute  that  they  cannot  be  seen 
with  the  naked  eye.  Some  of  them  have 
functions  which  are  useful  to  us,  and  some 
have  functions  which  are  prejudicial  to  us. 

Many  of  the  wonderful  phenomena  in 
nature  which  in  the  past  have  been  mys- 
teries to  us  are  caused  by  denizens  of  this 
kingdom.  Indeed,  only  a  few  of  them 
work  serious  harm  to  man,  and  even  the 
harm  which  these  do  is  not  out  of  harmony 
with  nature  as  a  whole. 

The  world  as  we  see  it  can  be  main- 
tained only  by  harmonious  succession  of 
life  and  death.  The  animal  and  vegetable 
kingdoms  to  a  great  extent  depend  each 
upon  death  in  the  other  for  the  mainten- 


1 2  hitroduction 

ance  of  life,  and  the  microscopic  kingdom 
which  is  now  being  revealed  to  us  seems 
to  stand  in  the  relationship  of  go-between, 
transforming  each  into  food  for  the  other. 

It  is  quite  possible  that  the  micro- 
organisms which  now  produce  what  is 
known  as  disease  originally  only  attacked 
dead  organic  tissue.  Their  primary  func- 
tion may  have  been  to  transform  dead 
organic  matter  into  inorganic  matter.  As 
living  organic  matter  degenerated,  thus 
approaching  nearer  and  nearer  to  dead 
organic  matter,  they  gradually  may  have 
acquired  the  power  of  growth  upon  living 
organic  matter.  Such  a  theor}^  is  the  more 
plausible  since  we  know  that  all  micro- 
organisms which  cause  disease  find  con- 
genial soil  in  a  living  organism  in  direct 
ratio  to  deterioration  of  the  latter  from  a 
normal  standard. 

If  man  by  reason  of  his  deviation  from 
the  laws  of  nature  through  self-will  has 
brought  disease   upon  himself  he  has  the 


Introduction  1 3 


power  in  the  intelligence  which  God  has 
given  him  likewise  to  rid  himself  of  such 
disease.  This  power  now  becomes  avail- 
able for  the  first  time  in  the  history  of  the 
world  through  the  new  knowledge  about 
the  microscopic  world.  The  micro-organ- 
isms which  work  harm  to  man  can  be 
singled  out  and  destroyed.  This  is  the 
task  which  science  presents  to  man  for  the 
twentieth  century. 

Consumption,  from  the  dawn  of  history 
to  the  present  day,  has  been  one  of  the 
worst  scourges  of  mankind.  Not  only  has 
it  afflicted  man  himself  but  every  kind  of 
brute  creation  with  which  man  is  closely 
associated.  It  strikes  at  man's  life  in  a 
way  that  brings  mental  anguish  as  well  as 
physical  suffering,  and  it  deals  him  out 
sorrow  and  want  when  it  cannot  reach  him 
with  death.  It  has  been  a  shackle  to  his 
progress  in  civilization,  a  mildew  upon  his 
physical  evolution,  and  a  leaven  of  decay 
to  his  morality.     In  the  past  it  has  shown 


1 4  Introduction 

itself  an  unconquerable  foe.  What  a  vic- 
tory for  the  human  mind  at  last  to  have 
brought  this  enemy  to  bay! 

Science  has  laid  before  the  world  the 
cause  of  consumption  with  mathematical 
exactness,  and  has  given  such  an  insight 
into  the  lives  of  the  micro-organisms  which 
produce  it  that  it  is  possible  to  plan  a  cam- 
paign against  the  disease  which  is  sure  to 
end  in  victory  for  the  human  race.  It  now 
remains  for  the  world  to  avail  itself  of  the 
knowledge  which  science  has  given  it,  and 
for  every  man,  woman,  and  child  to  enHst 
in  the  army  which  is  to  fight  the  battle. 
This  little  volume  is  sent  forth  to  seek 
recruits  and  prepare  them  for  the  crusade 
against  this  disease. 


CHAPTER  I 

What   Consumption   is 

CONSUMPTION  is  a  disease  which  is 
caused  by  the  growth  of  certain  micro- 
organisms in  the  tissues  of  our  bodies. 
These  micro-organisms  grow  in  us  in  the 
same  way  as  wheat,  timothy,  and  clover 
grow  in  a  field.  The  micro-organisms 
concerned  with  the  production  of  consump- 
tion are  the  tubercle  bacillus,  the  strepto- 
coccus, and  the  staphylococcus.  The  tu- 
bercle bacillus  is  the  chief  or  head  of  the 
house,  and  the  streptococcus  and  staphylo- 
coccus are  associates. 

Consumption  is  a  complicated  disease,  or, 
perhaps  more  correctly  speaking,  a  mixture 
of  diseases.  The  picture  of  human  suffer- 
ing, distress,  and  bodily  decay  which  we 
recognize  as  consumption  has  been  named 

15 


1 6  Crusade  against  Tuberculosis 

for  its  most  striking  symptom — waste  of 
the  body. 

The  word  consumption  means  burning 
up — destruction.  In  all  ages  and  in  all 
languages  the  disease  has  been  named 
for  this  symptom.  The  Greeks  called 
it  phthisis,  which  means  wasting.  This 
name  is  still  retained  by  the  Latin  races 
and  to  some  extent  is  used  in  English. 
The  Germans  call  it  Auszehrung,  which 
likewise  means  w^asting.  The  disease  is 
accompanied  with  burning  fever  and  pro- 
fuse sweats.  These  symptoms  quite  nat- 
urally give  a  fitting  background  to  the 
picture  of  consumption  or  destruction. 
The  body  is  melted  away  under  the  con- 
suming fire.  A  racking  cough  goes  with 
the  disease  and  helps  in  the  work  of 
destruction  by  carrying  off  the  wasted 
tissue.  The  hectic  flush  is  but  the  glow 
of  the  burning  fire  within. 

In  olden  tim.es  consumption  was  looked 
upon  as  a  simple   uncomplicated  disease, 


What  Consumption  is  17 

beginning  and  ending  with  the  same  symp- 
toms. Nothing  was  known  of  its  cause 
and  there  were  all  kinds  of  surmises  as  to 
what  it  might  be  due  to.  Hippocrates 
thought  it  came  from  some  subtle  poison 
generated  in  the  air  and  carried  by  certain 
winds.  No  doubt  this  was  the  accepted 
opinion  of  his  day. 

In  countries  in  which  very  cold  weather 
occurred  during  winter  and  in  which  rapid 
changes  of  temperature  took  place  in  sum- 
mer, it  was  ascribed  to  cold.  This  opinion 
still  is  held  by  many.  In  more  modern 
times  most  people  have  attributed  the  dis- 
ease to  an  inherited  tendency  to  decay. 
It  is  quite  possible  that  this  view  sprang 
from  a  strained  interpretation  of  the  Bible 
where  it  speaks  of  the  sins  of  the  father 
being  visited  upon  the  son  to  the  third 
and  fourth  generations. 

For  all  of  the  strange  views  about  the 

disease  held  in  the  past  plausible  reasons 

could  be  found  in  the  course  which  the 
2 


1 8  Crusade  against  Tuberculosis 

disease  ran  from  its  beginning  to  its  end 
as  then  understood.  But  as  only  the  end 
of  the  disease  was  recognized,  all  reason- 
ing upon  its  source,  being  based  upon 
incomplete  observation,  necessarily  was 
false. 

Consumption  now  is  known  to  be  a 
complicated  disease  of  very  long  duration, 
which,  like  the  butterfly  and  many  other 
insects,  looks  different  and  acts  very  differ- 
ently according  to  the  stage  of  its  exist- 
ence. During  its  pupal  stage,  when  it  is 
known  as  merely  tuberculosis,  it  is  hard  to 
detect,  because  it  creates  so  little  disturb- 
ance as  not  even  to  attract  the  attention  of 
the  person  afflicted.  It  may  exist  in  this 
stage  for  many  years. 

Usually  it  is  brought  to  light  by  some 
such  micro-organism  as  the  influenza  bacil- 
lus, the  pneumococcus  and  the  micro- 
organisms which  cause  what  are  com- 
monly termed  *'  colds."  As  a  rule,  it  is 
through  one  or  the  other  of  these  micro- 


What  Consumption  is  19 

organisms  that  the  streptococcus  and 
staphylococcus  are  introduced  to  it ;  and 
generally  it  is  during  the  struggle  of  one's 
system  against  these  micro-organisms  that 
the  wicked  partnership  between  the  tuber- 
cle bacillus  and  the  streptococcus  and 
staphylococcus  is  formed.  It  is  only  after 
the  formation  of  this  partnership  that  true 
consumption  exists  and  becomes  recog- 
nizable to  the  layman.  Even  the  average 
physician  does  not  recognize  it  earlier. 

The  striking  symptoms  of  consumption 
which  attract  the  attention  of  everyone  are 
due  to  the  poison  produced  by  the  strepto- 
coccus and  staphylococcus.  This  poison 
is  absorbed  into  the  blood  and  affects  the 
nervous  system. 

The  streptococcus  and  the  staphylo- 
coccus are  micro-organisms  which  occur 
almost  everywhere  in  nature.  They  look 
like  little  balls  strung  out  in  chains  or 
bunched  like  grapes,  and  are  given  their 
respective  names  because  of  their  respec- 


20  Crusade  against  Tuberculosis 

tive  resemblance  to  these  objects.  When 
they  get  into  the  tissues  of  the  body,  they 
break  down  these  tissues  into  pus.  For- 
tunately they  are  unable  to  attack  normal 
tissue.  It  seems  that  they  cannot  even 
gain  admission  into  a  living  organism 
except  through  tissue  which  has  been 
injured  either  by  the  application  of  physi- 
cal force  of  some  kind  or  by  the  growth 
of  some  other  micro-organism. 


CHAPTER  II 

What  Tuberculosis  is 

TUBERCULOSIS,  scientifically  speaking, 
is  the  implantation  and  growth  of  the 
tubercle  bacillus  in  the  tissues  of  a  human 
being  or  an  animal.  The  tubercle  bacillus 
is  a  rod-shaped  micro-organism,  about 
one-six-thousandth  of  an  inch  in  length 
and  about  one- hundred-thousandth  of  an 
inch  in  thickness. 

Naturalists  place  the  tubercle  bacillus  in 
the  vegetable  kingdom.  Bacteriologists,  as 
the  men  who  study  the  forms  and  habits  ■ 
of  micro-organisms  are  called,  classify  it  as 
a  facultative  saprophyte.  By  this  is  meant 
that  the  micro-organism  usually  exists  as 
a  parasite  upon  a  human  being  or  some 
animal,  but  that  it  has  the  power  of  grow- 
ing upon  such  substances  as  gelatine, 
boiled  potato,  and  the  like,  when  proper 

21 


22  Crusade  against  Ticberculosis 

conditions  of  temperature,  light,  and  rest 
are  given  it. 

A  saprophyte  is  a  micro-organism  which 
grows  upon  dead  organic  matter.  A  para- 
site is  a  micro-organism  which  grows  on 
living  organic  matter.  This  living  organic 
matter  is  called  the  host.  Only  when  the 
tubercle  bacillus  grows  as  a  parasite  in  the 
tissues  of  a  human  being  or  animal  is  the 
process  termed  tuberculosis. 

The  word  tuberculosis  is  derived  from 
the  little  Latin  word  tubeVy  which  means  a 
root  or  lump.  It  came  to  be  applied  to  the 
disease  which  it  now  designates  by  reason 
of  the  manner  in  which  certain  facts  about 
the  disease  gradually  came  to  light. 

When  men  began  to  make  autopsies  on 
people  who  had  died  of  consumption,  they 
were  surprised  to  find  in  those  parts  of  the 
lungs  which  had  not  been  completely  de- 
stroyed Httle  lumps,  ranging  in  size  from  a 
millet  seed  to  a  hickory  nut.  These  little 
lumps  were  found    in    larger  numbers  in 


What  Tuberculosis  is  23 

some  cases  than  in  others,  but  they  always 
were  present.  It  was  noticed,  too,  that 
the  little  lumps  were  sometimes  hard  and 
sometimes  soft.  The  thought  at  once 
suggested  itself  that  the  hard  lumps,  the 
soft  lumps,  and  the  holes  or  cavities  which 
also  were  found  were  all  stages  of  the 
same  process  and  that  the  beginning  of 
every  case  of  consumption  was  the  forma- 
tion of  these  little  lumps. 

In  the  scientific  language  of  that  day, 
which  was  Latin,  the  lumps  were  called 
tubercles,  and  the  process  which  took  place 
in  the  tissues  was  called  tuberculosis.  As 
consumption  was  looked  upon  as  an  out- 
ward manifestation  of  the  process  which 
was  going  on  inside  it  came  to  be  known 
among  scientific  men  as  tuberculosis. 
Gradually  the  laity  likewise  took  up  the 
name,  and  tuberculosis  and  consumption 
came  to  be  known  as  the  same  thing. 

Tuberculosis,  in  a  popular  sense,  is  not 
a  disease.     Disease  means  want  of  ease  or 


24  Crusade  against  Tuberculosis 

comfort,  and  in  common  parlance  is  only 
used  to  describe  a  condition  of  health  in 
which  the  affected  person  knows  that  he  is 
sick.  From  a  physician's  point  of  view 
tuberculosis  is  a  disease. 

No  difference  how  small  the  implanta- 
tion of  tubercle  bacilli  may  be  in  a  person, 
it  sets  up  symptoms  which  can  be  recog- 
nized by  an  expert.  These  symptoms 
are  deviations  of  functions  from  the  nor- 
mal, but  often  they  are  so  slight  and  have 
come  on  so  insidiously  that  the  transi- 
tion from  the  normal  to  the  abnormal  is 
overlooked  by  the  patient  and  his  friends. 
This  oversight  takes  place  the  more  easily 
because  many  of  the  symptoms  of  tubercu- 
losis occur  in  everyone's  life  as  the  result 
of  occupation,  use  of  improper  or  badly 
prepared  food,  and  residence  under  un- 
healthy environment. 

Inaptitude  for  occupation  and  fatigue 
upon  slight  exertion,  dyspepsia,  malnutri- 
tion, sensitiveness  to  cold,  want  of  appetite, 


What  Tuberculosis  is  25 

dislike  of  certain  kinds  of  food,  irritability, 
peevishness,  and  mental  depression  all  are 
symptoms  which  may  manifest  themselves 
in  tuberculosis,  but  they  also  are  the  com- 
mon inheritance  of  mankind  in  the  vicissi- 
tudes of  life  and  by  most  people  are  looked 
upon  as  natural  results  of  conditions  of  life 
over  which  they  have  no  control. 

When  any  or  all  of  these  symptoms 
occur  in  tuberculosis  they  are  only  part  of 
a  picture  which,  like  the  puzzle  picture  in 
the  newspapers,  must  be  filled  in  by  care- 
ful search  for  other  symptoms  which  exist, 
but  do  not  show  themselves.  Some  of 
these  hidden  symptoms  can  be  discovered 
by  a  layman,  others  only  reveal  themselves 
to  an  expert.  The  symptoms  discoverable 
to  a  layman  which  arouse  the  strongest 
suspicion  of  tuberculosis  are  loss  of  weight, 
slight  increase  in  pulse-rate,  and  slight  de- 
pression or  rise  of  temperature. 


CHAPTER  III 

The  Relationship  between 

Consumption  and 

Tuberculosis 

POPULARLY  speaking,  consumption  and 
tuberculosis  are  one  and  the  same  thing. 
Scientifically,  they  differ  quite  materially. 
In  the  interest  of  the  crusade  against  tuber- 
culosis it  is  important  that  the  relationship 
between  the  two  be  well  understood  by  the 
people. 

With  the  knowledge  which  is  now  in 
the  world,  among  the  people,  tuberculosis 
nearly  always  terminates  in  consumption. 
The  transition  is  so  gradual  as  to  be  imper- 
ceptible, and  usually  it  is  only  when  con- 
sumption has  set  in  that  the  existence 
of  tuberculosis  is  revealed.  Practically, 
therefore,    there  is    but    one    disease,    the 

26 


Consumption  and  Tuber cidosis         27 

beginning  of  which  goes  unrecognized,  and 
in  the  minds  of  most  people  is  a  mere  fic- 
tion. 

Tuberculosis  is  caused  by  the  implanta- 
tion and  growth  of  the  tubercle  bacillus. 
By  itself  this  micro-organism  does  little 
harm  and  rarely  causes  death.  Could  the 
streptococcus  and  the  staphylococcus  be 
kept  out  it  would  run  slowly  through  the 
lifetime  of  an  individual  without  serious 
consequences. 

Its  growth  in  the  tissues,  however,  in- 
vites the  streptococcus  and  staphylococcus 
to  those  tissues  by  the  injury  which  it 
does  to  them.  Sooner  or  later  these 
micro-organisms  run  the  gauntlet  of  the 
sentinels  which  nature  has  set  up  to  keep 
them  out,  and  get  into  the  system.  They 
at  once  associate  themselves  with  the 
tubercle  bacillus  and  form  a  partnership 
for  mutual  advantage  and  the  destruction 
of  the  individual  on  whom  they  prey. 
The  partnership  is  consumption. 


28  Crusade  against  Ttiberculosis 

The  streptococcus  and  the  staphylococ- 
cus are  essential  co -efficients  to  the  tubercle 
bacillus  for  the  completion  of  its  cycle  of 
life.  Without  them  the  tubercle  bacillus 
probably  would  soon  become  extinct.  They 
do  for  the  tubercle  bacillus  what  frost  does 
for  the  chestnut,  enable  it  to  escape  from 
imprisonment  so  that  it  may  again  start  on 
a  new  cycle  of  life.  They  also  make  a 
cache  for  it  so  as  to  protect  it  against  its 
many  enemies,  especially  air  and  sunlight, 
and  thus  preserve  its  life  until  it  can  by 
some  chance  be  carried  into  new  soil. 

The  little  tumors  or  lumps  which  are 
formed  in  the  tissues  by  the  growth  of  the 
tubercle  bacillus  consist  of  cells,  tubercle 
bacilli,  and  debris.  The  inside  of  the  little 
tumor  may  soften,  but  the  little  lump  re- 
mains more  or  less  firm,  and  the  tubercle 
bacilli  are  imprisoned. 

When  the  streptococcus  and  staphylo- 
coccus gain  admission  into  the  little  tumor, 
they  at  once  begin  a  work  of  destruction 


Consumption  and  Tuberculosis         29 

of  the  cells  and  produce  the  broken-down 
tissue  which  serves  as  the  covering  for  the 
tubercle  bacillus.  An  ulcerative  process 
also  is  begun  by  these  associates,  and  an 
opening  is  gradually  made  by  which  the 
tubercle  bacillus  again  gets  into  the  out- 
side world. 

It  is  during  the  time  when  the  tubercle 
bacillus  is  set  free  from  its  imprisonment 
that  the  symptoms  prevail  which  give  us 
the  picture  of  human  suffering  known  as 
consumption.  Thus  the  enfranchisement, 
the  marriage  feast,  so  to  speak,  of  this  in- 
visible bit  of  bioplasm  becomes  the  sorrow 
and  sore  affliction  of  the  highest  repre- 
sentative of  organic  life  on  earth.  How 
interdependent  is  all  organic  life ! 

The  first  implantation  of  the  tubercle 
bacillus,  even  when  followed  by  an  implan- 
tation of  the  streptococcus  and  staphylo- 
coccus, rarely  gives  rise  to  a  full-fledged 
consumption.  It  may  give  rise  to  a  process 
so  slight  as  not  to  attract  attention  during 


30  Crusade  against  Tuberculosis 

any  part  of  the  course  through  which  it 
passes. 

When  the  first  tubercle  matures  and  the 
bacilH  are  set  free  and  come  away,  there 
is  a  sHght  cough,  a  few  night-sweats,  per- 
chance, indisposition  for  a  week  or  two, — 
a  miniature  consumption,  so  to  speak,  but 
so  trifling  and  brief  as  to  pass  for  a  cold. 

During  this  process,  however,  a  new 
seed-scattering  takes  place,  a  new  im- 
plantation follows,  a  larger  growth  ensues, 
and  with  the  second  harvest  more  pro- 
nounced symptoms  occur.  The  interval 
between  the  two  processes  is  so  long  as  to 
obliterate  the  first  from  memory  before  the 
second  comes  on.  A  third  seed -scattering 
takes  place  with  the  same  sequences  as  the 
preceding  two,  and  again  with  a  larger  area 
of  implantation  than  the  one  immediately 
going  before. 

Attack  after  attack  comes  on  at  inter- 
vals of  longer  or  shorter  duration,  varying 
from  three  months  to  a  year,  each  severer 


Consumption  aiid  Tuberculosis.        31 

than  the  one  before,  each  a  miniature  con- 
sumption and  approaching  nearer  to  the 
real  thing  than  its  predecessor,  until  finally, 
as  with  the  orange  tree,  harvest  and  seed- 
time meet  and  there  is  one  continuous 
consumption  which  everybody  can  recog- 
nize. Usually,  this  is  the  time  when  the 
poor  deluded  victim  seeks  aid.  He  knocks 
at  the  doctor's  door,  and  the  undertaker 
answers. 


CHAPTER  IV 

What   Colds,  Influenza,  and 

Pneumonia  have  to  do 

with  Consumption 

COLDS,  influenza,  and  pneumonia  have 
been  looked  upon  as  causes  of  consumption 
and  by  many  still  are  regarded  as  such. 
A  neglected  cold,  repeated  attacks  of  in- 
fluenza, an  unhealed  pneumonia,  to  the 
lay  mind,  are  highways  to  consumption, 
which  like  the  roads  to  Rome  can  lead  no- 
where else.  A  half  truth  lies  hidden  back 
of  these  popular  notions  which  looks  so 
like  the  whole  truth  as  to  be  misleading. 

Colds,  influenza,  and  pneumonia  all  are 
caused  by  micro-organisms,  each  of  which 
is  an  independent  entity.  The  micro-or- 
ganism or  micro-organisms  which  produce 
colds  have  not  been  identified  as  yet,  but 

32 


Colds,  Influenza,  and  Pneumonia      33 

we  have  every  reason  to  believe  that  they 
exist.  It  is  possible  that  a  number  of 
micro-organisms  have  to  do  with  the  con- 
dition which  is  termed  a  cold.  The  micro- 
organisms which  cause  influenza  and  pneu- 
monia are  known.  One  is  a  bacillus,  and 
is  called  the  influenza  bacillus ;  the  other 
is  a  coccus,  and  is  known  as  the  pneumo- 
coccus.  These  diseases,  being  caused  by 
micro-organisms,  are  communicable  from 
one  person  to  another. 

Inasmuch  as  the  micro-organisms  which 
produce  colds,  influenza,  and  pneumonia 
are  independent  entities,  endowed  with  life 
and  the  essential  qualities  of  living  things, 
they  cannot  be  transformed  into  other  liv- 
ing things.  A  micro-organism  can  only 
reproduce  a  micro-organism  of  its  own 
kind,  and  therefore  a  disease  caused  by  one 
kind  of  micro-organism  cannot  give  rise 
to  a  disease  caused  by  another  kind  of 
micro-organism.  It  is  no  more  possible 
for   a   cold    micro-organism,  an    influenza 


34  Crusade  against  Tuberculosis 

bacillus,  or  a  pneumococcus  to  give  rise 
to  tuberculosis  than  it  is  for  a  grain  of  oats 
to  grow  into  a  stalk  of  wheat. 

Nevertheless,  the  cold  micro-organism, 
the  influenza  bacillus,  and  the  pneumo- 
coccus do  play  a  role  in  the  production  of 
consumption  which  usually  is  so  dramatic 
as  to  be  readily  mistaken  for  the  cause. 

A  person  may  have  tuberculosis  for  a 
long  time  without  knowing  it  because  there 
are  no  marked  symptoms.  Quite  suddenly 
a  cold,  an  influenza,  or  a  pneumonia  sets  in 
with  a  chill,  fever,  and  the  most  acute  in- 
disposition. The  person  at  once  knows 
that  he  is  ill  and  from  the  moment  of  seizure 
his  attention  is  riveted  upon  his   condition. 

Because  of  the  pre-existing  tuberculosis, 
the  cold,  influenza,  or  pneumonia  does  not 
run  a  normal  course,  but  shows  a  strong 
tendency  to  chronicity.  Finally,  as  it 
disappears  it  leaves  in  its  wake  well-devel- 
oped symptoms  of  comsumption,  which 
perhaps  for  the  first  time  bring  to  light  the 


Colds,  Influenza,  and  Pneicmo7iia      35 

pre-existing  tuberculosis.  How  natural 
for  the  patient  to  ascribe  his  consumption 
to  the  most  apparent  cause. 

The  part  which  the  cold  micro-organ- 
ism, the  influenza  bacillus,  or  the  pneumo- 
coccus  plays  in  such  cases  is  twofold,  that 
of  a  fertilizer  for  the  tubercle  bacillus,  and 
that  of  a  roadmaker  for  the  streptococcus 
and  staphylococcus. 

Colds,  influenza,  and  pneumonia  reduce 
the  vital  force  of  the  body,  and  thus  make 
the  tissues  a  better  soil  for  the  tubercle 
bacillus.  They  also  disarm  the  sentinels 
which,  stand  guard  against  the  admission 
of  the  streptococcus  and  staphylococcus 
and  often  bring  these  marauders  in. 

A  cold,  an  influenza,  or  a  pneumonia 
always  is  a  serious  matter  to  a  tubercular 
subject.  These  three  diseases,  figuratively 
speaking,  are  the  hunting  dogs  for  tuber- 
culosis, because  they  bring  the  disease  to 
light  when  its  existence  is  not  suspected. 
They  also  are  drummers  for  the  strepto- 


36  Crusade  against  Tuberculosis 

coccus  and  staphylococcus  and  constantly 
bring  trade  to  them  which  otherwise  they 
would  not  get.  They  are  in  business  for 
themselves,  but  they  don't  mind  doing  a 
little  commission  business  on  the  side. 
This  they  can  do  the  better  because  their 
own  business  paves  the  way  for  the  part- 
nership business  of  the  tubercle  bacillus 
and  the  micro-organisms  for  whom  they 
act  as  agents, 


CHAPTER  V 

What  Consumption  Means 
to  the  World 

IT  IS  beyond  the  grasp  of  the  human 
mind  to  fully  realize  what  consumption 
means  to  the  world.  The  disease  exists  in 
every  part  of  the  habitable  globe,  upon  the 
surface  of  the  earth,  underneath  the  waters, 
and  in  the  heavens  above.  It  probably  is 
the  direct  cause  of  death  of  one-seventh  of 
the  human  species,  and  a  fair  percentage  of 
the  animal  species.  It  affects  the  fishes 
of  the  sea  and  the  birds  of  the  air. 

True  knowledge  can  come  only  from 
personal  experience.  Knowledge  of  con- 
sumption is  restricted  by  the  experience  of 
the  individual,  and  the  sum  total  of  indi- 
vidual knowledge  upon  one  given  subject 
constitutes  pubhc  consciousness  upon  that 
subject. 

37 


38  Crusade  against  Tuberculosis 

Consumption  has  been  a  plague  upon 
the  earth  at  all  times  and  in  all  places, 
but  man  never  has  been  conscious  of  it. 
This  is  because  the  disease  is  devoid  of 
drama  and  tragedy. 

The  individual  sees  but  little  of  it  be- 
cause his  social  horizon  necessarily  is  cir- 
cumscribed. Within  the  family  the  disease 
is  a  family  affliction.  It  gives  no  idea  of 
what  is  going  on  beyond. 

Consumption  is  a  disease  of  the  poor.  It 
lurks  in  dark  corners.  No  one  sees  it  in 
the  aggregate.  Even  the  clergyman  and 
the  doctor  see  but  one  case  at  a  time  and 
see  relatively  few  cases  in  a  lifetime. 

Could  the  consumptives  of  any  given 
community  be  seen  at  one  time  or  pass  in 
panorama  before  the  people,  public  con- 
sciousness of  the  magnitude  of  the  afflic- 
tion might  be  aroused.  A  physical  disaster 
shocks  the  world  and  lets  loose  the 
sympathy  of  millions.  A  few  thousand 
deaths  are  nothing  as  compared  with  the 
deaths  from  consumption. 


What  Co7isumption  memis  39 

In  the  United  States  upward  of  one  hun- 
dred thousand  people  die  annually  from 
consumption.  In  Germany  the  number  of 
deaths  every  year  is  nearly  the  same;  and 
in  France  the  figures  stand  very  little 
below.  In  Austria  there  are  about  eighty 
thousand  deaths  a  year  from  the  disease  ; 
in  England  about  sixty  thousand;  in  Italy 
about  fifty  thousand.  Throughout  the 
world  there  probably  are  a  millon  deaths 
a  year  from  the  disease. 

Ever}^  community  has  its  litttle  army  of 
victims  of  the  disease,  but  they  are  seen 
only  in  ones  and  twos  and  make  no  im- 
pression. Could  they  be  massed  and  all 
the  armies  brought  into  one  composite 
picture,  what  a  harrowing  sight  they  would 
present ! 

The  death-rate  from  consumption  does 
not  give  a  true  picture  of  the  ravages  of 
the  disease.  It  does  not  even  tell  the 
truth  about  consumption.  When  tuber- 
culosis ends  fatally,  it  usually  does  so  by 


40  Crusade  against  Tttberctdosis 

way  of  consumption ;  but  not  all  deaths 
caused  by  consumption  are  so   recorded. 

Some  of  the  names  under  which  con- 
sumption parades,  even  with  propriety,  be- 
cause of  long  usage,  are  quite  misleading  to 
a  layman.  Marasmus,  for  instance,  would 
hardly  be  taken  for  the  same  disease  as 
consumption,  and  yet  it  is.  The  only 
difference  is  in  the  place  of  beginning  of 
the  micro-organisms.  Exactly  the  same 
micro-organisms  are  at  work.  In  maras- 
mus they  make  their  headquarters  in  the 
lymphatic  glands  of  the  belly ;  in  con- 
sumption they  make  them  in  the  lungs. 

When  the  tubercle  bacillus  in  union 
with  the  streptococcus  and  staphylococcus 
causes  death,  by' operating  in  some  other 
part  of  the  body  than  the  lungs  and 
lymphatic  glands  of  the  belly,  the  death 
usually  is  recorded  under  a  name  which 
gives  no  clue  to  the  real  cause  of  death. 

Usage  has  established  the  practice  of  re- 
cording deaths  by  a  name  which  indicates 


What  Consumption  means  41 


an  inflammation  of  the  organ  affected  by  the 
death-dealing  disease.  Pneumonia  means 
an  inflammation  of  the  lungs  ;  nephritis,  an 
inflammation  of  the  kidneys;  meningitis, 
an  inflammation  of  the  Hning  membrane 
of  the  brain ;  pericarditis,  an  inflammation 
of  the  membrane  around  the  heart ;  peri- 
tonitis, an  inflammation  of  the  peritoneum  ; 
and  pleurisy,  an  inflammation  of  the 
pleura.  Nothing  is  told  us  by  these  names 
about  the  cause  of  the  inflammation. 

The  tubercle  bacillus,  in  union  with  the 
streptococcus  and  staphylococcus,  fre- 
quently is  the  cause  of  inflammation  of 
these  organs  and  tissues  and,  when  it  is, 
often  leads  to  death.  The  death  certifi- 
cate, however,  fails  to  tell  about  the  work 
of  the  tubercle  bacillus  and  its  associates 
in  such  cases. 

What  consumption  means  to  the  world 
in  deprivation,  anguish,  grief,  and  degen- 
eration cannot  be  imagined  even.  We  can 
take  one  family  which  has  been  afflicted 


42  Crusade  against  Tuberculosis 

by  the  disease,  study  the  course  of  the  dis- 
ease from  beginning  to  end,  contemplate 
the  havoc  made  and  even  tr^^  to  analyze 
the  damage  done  financially,  physically, 
socially,  and  mentally,  but  we  cannot  read 
the  hearts  of  those  who  looked  on  while 
the  disease  was  torturing  and  killing  inch 
by  inch  a  loved  one ;  we  cannot  measure 
the  longing  hope  nor  fathom  the  deep 
despair  alternant  in  the  minds  of  the 
stricken  members;  we  cannot  measure  the 
heroism  of  those  who  stood  at  the  post  of 
duty  year  in  and  year  out,  realizing  their 
danger  but  unable  to  flee  from  it ;  and  we 
cannot  know  of  the  misanthropy,  envy, 
and  hatred  engendered,  and  perhaps  vir- 
tuously withstood,  whilst  helplessly  the 
stricken  family  stood  in  the  shadow  of 
affluence  and  wealth. 

Who  can  understand  the  mental  anguish 
created  by  a  fancied  remedy  for  a  fatal  dis- 
ease, withheld  by  poverty  in  the  midst  of 
plenty,  except  he  who  has  drunk  the  dregs 
of  such  poverty  ? 


CHAPTER  VI 

The  Prevalency  of 
Tuberculosis 

THE  denizens  of  the  microscopic  world, 
although  beyond  the  reach  of  the  naked 
eye,  usually  can  be  seen  through  their 
work.  What  they  accomplish  manifests 
itself  in  material  form  or  sets  up  changes 
in  material  things  which  can  be  recog- 
nize 1.  As  yet,  however,  man  is  not  well 
enough  informed  about  the  micro-organic 
world  to  be  quick  in  detecting  all  the 
phenomena  which  emanate  from  any  given 
member  of  that  world. 

Tuberculosis  as  a  manifestation  of  micro- 
organic  life  is  not  well  understood  as  yet. 
To  the  minds  of  most  men  the  word  tuber- 
culosis merely  conveys  the  idea  of  con- 
sumption. Men  know  consumption  but  do 
not  know  tuberculosis,  and  as  consumption 

43 


44  Crusade  against  Tuberculosis 

grows  out  of  tuberculosis  its  manifestations 
are  unconsciously  ascribed  to  tuberculosis. 
The  tuberculosis  is  overlooked  because  it 
is  sought  for  in  the  dress  of  consumption, 
just  as  a  larva  would  be  overlooked  when 
sought  for  in  the  form  of  a  butterfly. 

Tuberculosis  exists  in  the  world  to  a 
much  greater  degree  than  the  manifes- 
tations of  consumption  would  indicate. 
Many  cases  end  in  recovery  without  at- 
tracting attention.  Many  others  end  in 
death  from  some  other  disease  without 
the  existence  of  tuberculosis  ever  being 
suspected. 

Autopsies  upon  the  dead  bodies  of 
poor  people  who  have  died  in  charity 
hospitals  from  some  other  disease  than 
tuberculosis  reveal  the  existence  of  tuber- 
cular implantation  in  vastly  the  majority. 
This  would  seem  to  indicate  that  among 
people  in  the  lower  walks  of  life  nearly 
everybody  gets  an  implantation  of  tubercle 
bacilli  at  one  time  or  another. 


The  Prevalency  of  Tuberculosis      45 

Tuberculosis  can  develop  in  any  part 
of  the  body.  The  tubercle  bacillus  ap- 
parently finds  a  more  congenial  culture 
medium  in  some  tissues  than  in  others, 
but  can  grow  in  any  tissue. 

The  lungs  seem  to  be  the  seat  of  predi- 
lection. The  lymphatic  glands  and  the 
serous  membranes  are  favorite  media.  The 
bones  and  the  organs  in  the  abdomen  quite 
often  are  the  places  of  beginning.  The 
skin,  the  mucous  membranes,  the  eye,  the 
ear,  and  even  the  brain  may  be  the  seat  of 
growth. 

There  are  many  chronic  diseases  well 
known  to  the  people,  which  are  tuberculo- 
sis but  travel  under  aliases.  The  real  char- 
acter of  these  diseases  is  never  suspected. 

Scrofula  nearly  always  is  due  to  the 
growth  of  the  tubercle  bacillus  in  lymphatic 
glands.  Lupus  is  tuberculosis  of  the  skin. 
White  swelling  is  tuberculosis  of  the  bone. 
Spine  disease  is  tuberculosis  of  the  vertebrae. 
Hip    disease    is  tuberculosis    of  the   head 


46  Crusade  against  Tuberculosis 

of  the  thigh  bone.  Fistula,  in  many  cases, 
is  tuberculosis  of  the  perineum.  Water  on 
the  brain  is  tuberculosis  of  the  serous  mem- 
branes lining  the  brain.  Marasmus,  or 
"take  off"  as  it  is  sometimes  called,  is 
tuberculosis  of  the  lymphatic  glands  of 
the  mesentery. 

Many  well-known  deformities  are  the 
result  of  tuberculosis  which  has  run  its 
course  and  gotten  well.  Nearly  all  spinal 
curvatures  are  due  to  tuberculosis.  The 
pitiful  little  hunchback  has  been  made 
so  by  tuberculosis.  Nearly  all  stiff  joints 
have  been  put  out  of  use  by  tuberculosis. 
The  unsightly  scars  which  frequently  are 
seen  on  the  necks  of  people  mostly  are  of 
tubercular  origin. 

Monstrous  as  tuberculosis  looks  when 
arraigned  under  all  its  aliases,  its  injury 
to  the  human  family  can  by  no  means 
be  measured  by  its  direct  ravages.  Its 
indirect  damage  to  mankind  is  perhaps 
even  greater  than  its  direct. 


The  Prevalency  of  Tuber ciilo sis      47 

Our  insane  asylums,  orphan  asylums, 
almshouses,  houses  of  refuge,  reforma- 
tories, prisons,  and  penitentiaries  shelter  the 
indirect  results  of  tuberculosis;  but  who 
can  sift  these  results  out  from  the  general 
debris  of  sin  and  disease,  and  measure 
them? 


CHAPTER  VII 

How  Consumption  Came 
into  the  World 

WHERE  did  the  first  case  of  consump- 
tion come  from?  This  question  frequently 
is  propounded  as  a  knockdown  argu- 
ment against  the  micro -organic  nature  of 
consumption. 

The  answer,  when  asked  for  this  pur- 
pose, is.  Where  did  the  first  man  come 
from?  All  organic  nature  came  from  the 
same  source  and  was  endowed  with  life  by 
the  same  power. 

Man  views  with  disfavor  that  which 
does  not  serve  his  selfish  ends.  It  is 
hard  for  him  to  comprehend  why  micro- 
organisms which  bring  him  sorrow  and 
distress     should     spring    from    the    same 

48 


Whence  Consumption  Came  49 


source  as    himself.      The   Irreverant    even 
blaspheme  because  disease  is  in  the  world. 

For  the  preservation  of  nature  as  it  is, 
micro-organisms,  which  have  for  their  func- 
tion the  breaking  up  of  worn-out  organic 
matter  into  inorganic,  are  essential.  With- 
out them  the  earth  would  soon  be  littered 
up  with  organic  matter  out  of  which  life 
had  gone  for  one  reason  or  another,  and 
there  would  not  be  room  enough  left  to 
turn  around  in. 

Only  for  micro-organisms  the  vegetable 
kingdom  would  become  extinct  for  want 
of  food,  and  all  animal  creation  would  die 
for  the  same  reason.  Micro-organisms  are 
links  in  the  chain  of  metamorphosis  be- 
tween organic  and  inorganic  matter,  the 
severing  of  which  would  stop  the  process. 

Disease  germs,  in  all  probability,  are 
descended  from  micro-organisms  which 
in  the  original  design  of  nature  had  for 
their  function  the  transformation  of  or- 
ganic into  inorganic  matter.     That  by  sin 


50  Crusade  against  T^iberculosis 

death  came  into  the  world  may  be  literally 
true. 

Abuse,  excess,  and  dissipation  may  have 
reduced  the  vitality  of  the  human  body 
to  such  a  degree  as  to  make  it  easy  for 
micro-organisms,  whose  function  was  sapro- 
ph}i:ic  only,  to  become  parasitic.  With 
time  and  opportunity,  through  the  process 
of  evolution,  new  kinds  of  micro-organisms 
may  have  sprung  up  with  the  order  oi  pro- 
pensity reversed,  becoming  primarily  para- 
sitic and  secondarily  saprophytic. 

Consumption  is  a  mixed  disease.  The 
streptococcus  and  staphylococcus,  which 
are  secondary  micro-organisms  but  essen- 
tial to  the  disease,  still  are  saprophytes 
ordinarily.  They  become  parasites  when 
tissue  has  been  prepared  for  them.  They 
cannot  attack  normal  tissue.  In  consump- 
tion they  depend  upon  the  tubercle  bacillus 
for  their  standing. 

The  tubercle  bacillus  is  the  primary 
factor.     It  starts  in  business  by  itself,  but  it 


Whence  Consumption  Came  51 

does  only  enough  damage  to  make  it  possi- 
ble for  more  destructive  micro-organisms  to 
get  in. 

There  are  many  reasons,  at  hand  already, 
for  believing  that  the  tubercle  bacillus  is  a 
product  of  evolution.  The  chief  one  is  the 
resemblance  of  tuberculosis,  leprosy,  and 
syphilis  one  to  another. 

The  micro-organisms  which  produce 
tuberculosis  and  leprosy  are  well  known, 
and  the  micro-organism  which  produces 
syphilis  is  suspected.  The  tubercle  bacillus 
and  the  leprosy  bacillus  look  so  much 
alike  as  to  be  easily  mistaken  one  for  the 
other,  and  the  micro-organism  which  has 
been  introduced  to  science  as  the  syphilis 
bacillus  looks  enough  like  the  other  two 
to  be  a  brother. 

The  micro-organisms  which  produce 
these  diseases  probably  have  a  com- 
mon ancestry  in  much  the  same  way 
as  wheat,  rye,  and  barley  probably  have 
a    common     ancestry.      They    have    be- 


52  Crusade  against  Tuberculosis 

come  distinct  independent  living  organic 
entities,  however,  and  cannot  now  repro- 
duce one  another  or  set  up  any  other  dis- 
ease than  the  one  to  which  they  ordi- 
narily give  rise.  The  tubercle  bacillus 
always  produces  tuberculosis;  the  leprosy 
bacillus,  leprosy  ;  and  the  syphilis  bacillus, 
syphilis. 

Historically  it  can  be  established  that 
consumption  has  existed  as  we  know  it 
for  at  least  three  thousand  years.  Further- 
more, we  may  infer  that  it  had  existed  for 
a  long  while  before  we  read  of  it  in  historic 
writings. 

Moses  is  credited  with  a  knowledge  of 
consumption  by  commentators  of  the  Bible. 
His  figures  of  speech  in  Leviticus,  chapter 
XXVI,  verses  13-16,  and  in  Deuteronomy, 
chapter  xxviii,  verses  20-22,  probably 
were  inspired  by  the  disease. 

Some  claim  that  one  of  the  plagues 
spoken  of  by  Moses  as  having  afflicted 
the  Egyptians  was  consumption. 


Whence  Consumption  Came  53 


Isaias  probably  refers  to  consumption  in 
chapter  x,  verses  16-23,  and  Daniel  appears 
to  have  it  in  mind  in  chapter  x,  verse  17. 
Hippocrates   in  the  fifth  century  before 
Christ  gave  a  perfect  description  of  con- 
sumption   and    delineated    its    ravages    so 
well  as  to  make  the  picture  which  he  drew 
of  it  appear  like  an  exaggerated  drawing 
of  what  we   see  around  about  us  at   the 
present    day.     The    disease    evidently  was 
much    more  prevalent  in  his  day  than  it  is 
now. 

Galen  paints  the  disease  as  he  saw  it 
among  the  Romans  in  the  second  century 
after  Christ  in  even  brighter  colors  than 
did  Hippocrates.  From  Galen's  day  to 
modern  times  the  story  about  the  disease 
is  much  the  same. 

The  Romans  took  their  knowledge  of 
consumption  from  the  Greeks,  and  it  is 
quite  possible  that  they  got  the  dis- 
ease from  them  likewise.  The  Greeks 
are  believed   to  have  taken  their  knowl- 


54  Crusade  against  Tuberculosis 

edge  of  medicine  from  the  Egyptians.  It 
may  be  that  they  also  got  consumption 
from  them. 

Back  of  the  Egyptians  we  can  only  sur- 
mise that  the  disease  may  have  come  from 
the  East  out  of  the  dim  vista  of  early  civil- 
ization. The  buried  records  which  now  are 
being  unearthed  and  deciphered  may  give 
us  new  hght  on  the  subject. 


CHAPTER  VIII 

Is   Consumption 
Inherited? 

THAT  which  a  man  seeth  he  believeth. 
Consumption  in  all  times  has  been  a  family 
disease.  It  is  so  now.  Whole  families  fall 
victims  to  it.  Father,  son,  and  grandson 
get  it.  Uncles  and  aunts,  nephews  and 
^nieces,  follow  each  other  in  perfect  order  as 
victims. 

Occasionally  there  is  a  truce.  A  whole 
generation  escapes,  and  then  quite  sud- 
denly the  disease  reappears  in  a  new  gen- 
eration and  strikes  a  member  who  closely 
resembles  a  grand- uncle  or  grand-aunt 
who   has  died  of  it. 

Death,  moreover,  may  come  to  the  re- 
spective generations  at  the  same  time  of  life. 

55 


56  Crusade  against  Tuberculosis 

The  father  died  of  the  disease  at  thirty, — 
the  sons  died  at  thirty,  and  the  grand- 
sons die  at  thirty.  What  but  inheritance 
can  explain  these  phenomena  ? 

Our  knowledge  of  the  biology  of  the 
tubercle  bacillus  makes  intelligible  to  us 
this  strange  course  of  consumption  and 
solves  the  riddle  of  heredity.  It  makes 
clear  to  us  many  things  which  heretofore 
could  not  be  understood  except  upon  the 
theory  of  heredity. 

The  cycle  of  life  of  the  tubercle  bacillus 
may  be  interrupted  without  death,  either  in 
the  body  or  out  of  it.  It  is  with  it  as  with" 
wheat  or  rye  or  any  plant  which  grows 
from  a  seed.  If  a  grain  of  wheat  is  kept 
in  a  dry  place  it  will  maintain  its  power 
of  germination  and  growth  for  years  and 
perhaps  centuries.  The  cycle  of  life  is 
interrupted,  but  life  is  not  destroyed. 

In  the  body  the  tubercle  bacillus  may 
lie  dormant  for  a  long  time.  Like  grass  in 
a  worn-out  field,  it  may  grow  so  poorly  as 


Is  Consumption  Inherited?  57 

merely  to  keep  alive.  This  is  apt  to  occur 
when  implantation  has  taken  place  in  tissue 
which  has  a  sparse  blood  supply,  such  as 
lymph-glands.  It  also  may  happen  when 
the  person  in  whom  implantation  has  taken 
place  lives  a  vigorous,  healthy  life,  out  of 
doors,  thus  making  bad  soil  for  the  bacillus 
and  completely  shutting  out  the  associate 
micro-organisms. 

Then,  too,  nature,  in  her  effort  at  cure, 
may  wall  in  an  entire  colony  of  bacilli 
and  shut  them  off  from  the  healthy  tissue 
by  deposits  of  lime  on  the  outside  of 
the  tubercle  or  little  lump  which  contains 
them.  The  cycle  of  life  of  the  bacillus  is 
interrupted,  and  the  disease  lies  dormant 
for  years.  The  bacillus  hibernates,  so  to 
speak. 

At  any  time  during  the  lifetime  of  the 
individual,  when  more  favorable  condi- 
tions have  arisen  for  the  growth  of  the 
tubercle  bacillus  or  when  the  impris- 
oned  bacilli   have  been   set  free,  perhaps 


58  Crusade  against  Tuberculosis 

through  the  intervention  of  some  other 
micro-organism,  such  as  the  streptococcus 
and  staphylococcus,  activity  of  the  disease 
may  be  renewed  and  progress  again  be 
made.  An  implantation  which  has  taken 
place  in  infancy  may  reach  full  growth  of 
the  disease  only  in  middle  life  or  old  age. 

The  cycle  of  life  of  the  tubercle  bacillus 
also  may  be  interrupted  for  many  years 
outside  of  its  host.  A  lump  of  dried 
tubercular  matter  contains  millions  of 
living  tubercle  bacilli.  They  are  like 
wheat  in  a  granary.  So  long  as  they  are 
protected  against  the  elements  they  retain 
life,  and  as  soon  as  they  are  placed  in 
proper  soil  they  will  grow. 

In  houses  in  which  consumptives  live, 
lumps  of  dried  tubercular  matter  sometimes 
lurk  in  dark  corners,  where  they  lie  hidden, 
protected  against  the  elements,  for  years. 
Time  disintegrates  them,  and  future  house- 
wives, the  mothers  of  second  generations 
of    the    families,    may   wield   the   brooms 


Is  Consu7nption  Inherited?  59 

which  distribute  the  pulverized  matter  for 
inhalation. 

Consumption  therefore  is  a  family  dis- 
ease on  account  of  the  life  history  of  the 
tubercle  bacillus  rather  than  of  heredity. 
The  disease  clings  to  families  for  genera- 
tions because  the  conditions  for  implanta- 
tion and  growth  of  the  bacillus  and  for 
the  completion  of  its  cycle  of  life  exist 
best  in  the  family,  and  the  bacillus  may 
lie  in  houses,  as  wheat  in  a  granary,  for 
generations.  Then,  too,  consumption  in  a 
family  helps  to  produce  soil  for  the  tubercle 
bacillus  in  other  members  through  the 
hardships,  want,  and  sorrow  which  it  be- 
gets. 

Sometimes  consumption  reappears  in  a 
family  a  generation  or  two  after  having 
vanished,  because  exhausted  soil  has  been 
replenished.  There  has  been  temporary 
immunity. 

The  old  ideas  about  heredity  of  con- 
sumption are  no  longer  tenable.     They  are 


6o  Crusade  against  Tttberculosis 

at  variance  with  facts  which  are  fully  estab- 
lished. Consumption  is  due  to  micro- 
organic  life.     It  cannot  be  inherited. 

The  micro-organisms  which  produce  con- 
sumption are  independent  entities,  each 
of  which  lives  through  a  life  history  of 
its  own.  They  must  have  a  beginning 
and  an  end,  and  they  can  only  maintain 
their  kind  by  reproduction.  They  need 
certain  soil,  certain  temperature,  and  cer- 
tain environments  for  growth  and  de- 
velopment. Even  while  dormant  they 
must  have  certain  protection  against  their 
many  enemies. 

Consumption  cannot  be  placed  in  the 
same  category  with  traits  of  character,  color 
of  hair,  and  physical  form.  These  quali- 
ties are  transmitted  because  they  are  essen- 
tial to  the  organism.  The  transmission 
of  parasites  would  be  a  different  matter. 

Exceptionally  parents  may  convey  tuber- 
culosis to  their  offspring ;  but  as  a  disease, 
and   not  as  a   qualit>^  of  body  which  may 


Is  Con  sumption  Inherited?  6i 

change  into  a  disease.  They  even  may- 
transmit  the  tubercle  bacillus  in  a  dor- 
mant state,  embedded  in  the  body  of  the 
offspring  from  the  earliest  developmental 
stage,  to  become  active  and  develop  at 
any  time  during  life.  The  activity,  when 
it  arises,  however,  is  a  continuation  of  a  life 
history  which  was  begun  at  the  time  of 
implantation. 

In  such  cases  the  disease  transmitted 
does  not  constitute  an  inheritance  in  the 
old  sense.     It  rather  is  a  contagion. 

Transmission  of  tuberculosis  from  parent 
to  offspring,  even  in  the  limited  sense  here 
indicated,  is  of  infrequent  occurrence.  All 
the  fundamental  laws  of  nature  conspire 
against  it. 


CHAPTER  IX 

Predisposition  to  Con- 
sumption 

THE  discovery  of  the  micro-organisms 
of  consumption  has  diverted  attention  from 
secondary  causes,  which  should  not  be  lost 
sight  of  in  a  crusade  against  the  disease. 

These  causes  are  of  two  kinds,  those 
which  arise  from  within  and  those  which 
arise  from  without  the  individual  who  gets 
the  disease.  The  causes  which  arise  from 
within  the  individual  are  expressed  by  the 
word  predisposition. 

Predisposition  to  consumption  is  a  com- 
plex condition  which  is  hard  to  define.  It 
is  one  of  those  things  which  we  all  agree 
exists,  because  we  see  it  illustrated  in 
everyday  life;  but  we  all  seem  to  have  the 
same  indefinite  ideas  about  it. 

62 


Predisposition  to  Consumption  63 

Two  people  living  under  the  same  envi- 
ronments and  conditions,  enjoying  equal 
health,  are  exposed  to  consumption  in  ex- 
actly the  same  way ;  one  develops  the  dis- 
ease and  the  other  does  not. 

Two  families  in  the  same  walk  of  life 
are  subjected  to  the  same  kind  of  hardships 
and  live  under  equally  favorable  conditions 
for  implantation  of  the  disease ;  in  one 
family  the  disease  breaks  out,  in  the  other 
it  does  not. 

A  number  of  white  men  and  a  number 
of  colored  men  of  the  same  physique  and 
average  health  are  exposed  to  the  same 
danger  of  getting  consumption ;  for  every 
white  man  who  takes  the  disease  three 
colored  men  contract  it. 

Out  of  these  observations  we  have  for- 
mulated the  proposition  that  there  is  a  pre- 
disposition to  consumption ;  or,  in  other 
words,  that  some  people  are  more  prone  to 
contract  the  disease  than  are  others. 

Predisposition  can  be  classified  as  indi- 


64  Crusade  against  Tuberculosis 

vidual  predisposition,  family  predisposition, 
and  race  predisposition. 

In  every  family  there  is  a  certain  order 
in  which  the  members  will  fall  victims  to 
the  disease.  There  is  a  pronest  member 
and  a  least  prone  member. 

Individual  predisposition  usually  is  ac- 
quired and  may  be  the  result  of  previous 
disease,  depraved  habits,  want,  hardships, 
or  great  sorrow. 

Family  predisposition  is  a  family  matter 
and  goes  with  entire  families  or  with  mem- 
bers of  a  family  who  resemble  one  or  the 
other  parent,  or  one  or  another  ancestor. 
Families  sometimes  show  such  a  proneness 
that  they  almost  become  extinct  through 
the  disease. 

Family  predisposition  to  consumption 
largely  has  been  responsible  for  the  old 
ideas  about  heredity  of  consumption.  Ap- 
parently there  has  been  a  mix-up  of  ideas 
about  primary  and  secondary  causes. 

Race   predisposition   to  consumption   is 


Predisposition  to  Co7tsumption  65 

perhaps  the  most  noticeable  of  the  three 
kinds  because  it  is  the  most  striking. 

The  newer  the  race  in  the  order  of 
history  and  civiHzation,  apparently,  the 
more  prone  it  is  to  consumption. 

The  American  Indian  and  the  negro 
have  a  very  strong  predisposition  to  the 
disease.  The  Gentiles  are  more  predis- 
posed than  the  Jews. 

Among  Christian  peoples  those  of  Celtic 
and  Teutonic  origin  seem  to  have  a  stronger 
predisposition  than  those  of  Latin  and 
Greek  origin. 

Science  has  not  yet  told  us  what  predis- 
position is.  There  are  two  plausible  theo- 
ries upon  the  subject,  but  nothing  has  been 
determined  definitely. 

Some  hold  that  it  is  an  absence  of  some- 
thing from  the  system  of  a  person  which, 
if  present,  would  fight  off  the  disease. 
Others  hold  that  it  is  the  presence  of  some- 
thing in  the  tissues  of  a  person  which  con- 


66  Crusade  against  Tuberculosis 

stitutes  soil  for  the  micro-organisms.    There 
may  be  truth  in  both  views. 

It  has  been  demonstrated  that  a  living 
organism  has  within  itself  powers  of  self- 
defense  against  parasitism  and  that  these 
powers  grow  with  use. 

On  the  other  hand,  we  know  from  ob- 
servations in  the  vegetable  kingdom  that 
plants  will  not  grow  unless  the  earth  in 
which  they  are  planted  contains  certain 
ingredients,  the  presence  of  which  consti- 
tutes soil. 

Both  views  in  a  measure  explain  the 
facts  as  we  observe  them.  Ultimately,  no 
doubt,  science  will  give  us  exact  knowledge 
upon  the  subject. 

The  relative  value  of  predisposition  as  a 
factor  in  the  spread  of  consumption  cannot 
be  determined  until  we  have  more  exact 
knowledge.  At  present  we  can  take  it  only 
at  its  face  value,  which  may  be  much  in- 
flated. 

The  spread  of  consumption  is  a  com- 


Predisposition  to  Consumption  67 


plex  subject.  Personal  habits,  family  prac- 
tices, and  national  customs  may  exercise 
influences  in  the  spread  of  the  disease 
which  are  mistaken  for  predisposition.  The 
idea  of  predisposition  to  disease,  however, 
is  in  harmony  with  well-known  funda- 
mental laws  of  nature,  and  already  has  much 
strong  scientific  backing. 


CHAPTER   X 

Diseases  which  Predispose 
to  Consumption 

CERTAIN  diseases  become  secondary- 
causes  of  consumption,  by  depraving  the 
organism,  reducing  it  below  the  normal 
standard,  and  perhaps  also  by  making  soil. 

It  is  a  fact  well  known  to  farmers  that 
certain  plants  prepare  the  soil  for  other 
plants. 

The  diseases  which  predispose  to  con- 
sumption are  of  two  kinds,  those  which 
change  the  contour  of  the  body  or  of  any 
of  its  organs,  and  those  which  weaken  the 
constitution  or  modify  the  tissues  of  the 
body.  To  the  former  belong  rickets,  post- 
nasal adenoid  growths,  rheumatism,  and 
gonorrhea  ;  to  the  latter  smallpox,  measles, 
whooping-cough,  tj^phoid  fever,  syphilis, 
and  pneumonia. 

68 


Other  Diseases  and  Constimption     69 

Rickets  is  a  disease  of  malnutrition,  oc- 
curring in  childhood.  It  deforms  the 
body.  What  is  known  as  chicken-breast 
is  due  to  rickets. 

A  deformed  chest  may  lessen  the  capac- 
ity of  the  lungs,  and  by  so  doing  may 
interfere  with  nutrition  of  the  body.  It  also 
may  interfere  with  the  physiologic  action 
of  parts  of  the  lungs  and  thus  cause  such 
parts  to  be  in  a  state  of  passive  congestion. 
In  either  event  it  prepares  the  way  for  con- 
sumption. 

In  the  back  part  of  the  nose  there  is 

glandular  tissue,  which  technically  is  called 
adenoid  tissue.  In  childhood  this  fre- 
quently enlarges  through  colds  and  mal- 
nutrition, and  is  then  called  a  growth.  The 
enlargement  interferes  with  breathing 
through  the  nose,  and  brings  about  what 
is  known  as  mouth-breathing. 

A  predisposition  to  consumption  is  thus 
created.  The  enlarged  tissue  becomes  an 
inviting    field  for  tubercular   implantation, 


70  Crusade  against  Tuberculosis 

and  the  mouth-breathing  takes  away  from 
the  organism  the  protection  which  nature 
sets  up  in  the  nose  against  entrance  of 
micro-organisms. 

Rheumatism  may  become  a  predisposing 
cause  of  consumption  by  injuring  the  valves 
of  the  heart,  or  by  setting  up  an  inflam- 
mation and  producing  a  thickening  of 
serous  membranes,  such  as  the  pleura,  the 
pericardium,  and  the  lining  membranes  of 
the  joints. 

An  injured  heart  often  leads  to  mal- 
nutrition of  the  whole  body  and  to  bad 
circulation  of  the  lungs.  Both  favor  im- 
plantation of  the  tubercle  bacillus.  Thick- 
ened serous  membranes  are  good  soil  for 
the  tubercle  bacillus. 

Gonorrhea  prepares  the  way  for  tubercu- 
losis by  injuring  the  organs  which  it  affects. 
It  sets  up  an  inflammation  which  changes 
the  tissues  and  makes  of  them  good  soil  for 
the  tubercle  bacillus.     The  organs  which 


Other  Diseases  and  Consumption      71 

usually  are  damaged  by  gonorrhea  often 
become  the  seat  of  tuberculosis. 

Smallpox,  measles,  whooping-cough, 
typhoid  fever,  syphilis,  and  pneumonia 
are  given  credit  for  making  soil  for  con- 
sumption. They  frequently  are  forerunners 
of  it.  The  going  before,  however,  may  be 
a  mere  coincidence.  Consumption  is  such 
a  common  disease  that  other  diseases,  as  a 
matter  of  chance,  often  must  precede  it. 

Then,  too,  mistakes  are  made.  Tubercu- 
losis in  the  early  stages  is  sometimes  taken 
for  whooping-cough ;  a  tubercular  inflam- 
mation of  an  upper  lobe  of  the  lung,  when 
very  acute,  often  is  called  pneumonia ;  and 
a  tubercular  inflammation  of  some  of  the 
tissues  and  organs  of  the  belly  may  be 
called  typhoid  fever. 

These  cases  are  tuberculosis  from  the 
beginning.  Usually  the  acute  symptoms 
subside  and  fair  health  returns ;  but  in  due 
time  consumption  shows  itself.  The  dis- 
ease for  which  the  initial  symptoms  were 


72  Crusade  against  Tuberculosis 

mistaken  gets  the  credit  of  being  the  cause 
of  the  consumption. 

All  of  these  diseases  may  produce  soil 
for  consumption  by  injuring  the  tissues 
which  they  affect. 

Some  of  them  probably  merely  stimulate 
into  activity  dormant  tuberculosis.  The 
bronchial  lymphatic  glands  which  are  situ- 
ated along  the  air-passages  often  are  the 
seat  of  dormant  tuberculosis. 

Measles,  whooping-cough,  and  smallpox 
are  accompanied  by  inflammation  of  the  air- 
passages  and  sometimes  by  congestion  of 
the  lungs. 

This  inflammation  and  congestion  stim- 
ulate the  dormant  tuberculosis  into  an 
active  one,  and  when  the  symptoms  of 
the  current  disease  have  passed  away,  the 
symptoms  of  tuberculosis  remain  and 
gradually  attract  attention. 

Quite  naturally  the  disease  which  pre- 
ceded the  tuberculosis  is  given  credit  for 
having  brought  it  on. 


Other  Diseases  and  Co7isii77iption     ^-i^ 

Whether  or  not  any  of  the  diseases 
mentioned  produce  soil  for  tuberculosis 
in  the  sense  in  which  one  plant  is  believed 
to  produce  soil  for  another  cannot  be  de- 
termined with  the  scientific  data  now  at 
hand.  It  may  be  so,  but  the  probabilities 
are  that  when  tuberculosis  follows  another 
disease  the  succession  is  a  coincidence  and 
not  an  effect. 

As  a  matter  of  course  all  diseases  re- 
duce vitality,  and  temporarily,  until  the 
organism  has  recovered  itself  fully,  pave 
the  way  for  other  diseases. 


CHAPTER    XI 

Dissipation   as   a 

Predisposing  Cause  of 

Consumption 

DISEASE  and  death  are  the  wages  of  sin. 
When  the  black  sheep  of  a  family  meets 
with  an  early  death  usually  it  is  by  way  of 
consumption. 

In  olden  times  this  was  attributed 
directly  to  God's  anger  coupled  with  His 
mercy.  Consumption  overtook  the  sinner 
in  order  that  he  might  repent. 

We  no  longer  attribute  disease  to  an 
angry,  avenging  Providence,  and  yet  our 
most  advanced  thought  cannot  divorce  dis- 
ease entirely  from  sin. 

Transgression  of  the  laws  of  nature  is 
tantamount  to  transgression  of  the  laws  of 
God  and  brings  in  its  train  a  penalty  which, 
even  though  it  come  in  the  natural  order 

74 


Dissipation  and  Consumption  75 

of  things,  may  well  be  accepted  as  com- 
ing from  God. 

Dissipation  is  a  scattering  of  vital  forces 
by  an  excessive  indulgence  of  any  kind. 
It  always  strikes  at  the  most  vulnerable 
point,  the  nervous  system.  This  is  true 
even  when  the  indulgence  seems  to  feed 
the  body  rather  than  to  waste  it. 

Whatever  makes  for  lowered  vitality 
makes  for  consumption.  Lowered  vitality 
means  good  soil.  This  is  true  of  lowered 
vitality,  not  only  as  indicated  by  body- 
weight,  color  of  skin,  and  muscular  develop- 
ment, but  by  nerve  force. 

Degeneracy  of  the  nervous  system  is  the 
most  potent  factor  in  predisposing  causes 
of  consumption.  Some  writers  have  been 
led  into  the  error  of  looking  upon  it  as 
the  primary  cause  of  tuberculosis. 

In  youth  the  dissipations  which  directly 
or  indirectly  grow  out  of  the  affinities  of 
the  sexes  become  predisposing  causes  of 
consumption.     Self-abuse,  sowing  of  wild 


"^^  Crusade  against   Tuberculosis 

oats,  beau-catching,  courting,  and  all  the 
arts  and  devices  which  go  with  them 
in  these  times,  make  soil  for  tuberculosis 
and  often  lead  to  it.  They  all  exhaust 
the  nervous  system. 

Loss  of  sleep  is  an  important  factor  in 
this  nerve  exhaustion.  Especially  is  this 
true  of  the  working  classes,  who  often  work 
all  day  and  frolic  half  the  night. 

The  various  kinds  of  stimulants  play  a 
double  part  in  this  physical  wreck  ;  they 
injure  the  nutritive  system  and  they  spur 
on  to  further  abuse  when  the  nervous 
s\-stem  complains.  Alcoholic  beverages, 
tea,  coffee,  and  tobacco  are  used  to  keep 
up  and  quiet  the  nervous  system  under  the 
strain. 

The  death-rate  from  consumption  bounds 
up  eight  hundred  per  cent,  between  the  ages 
of  fifteen  and  twenty-five  years,  and  this, 
too,  during  the  life  period  which  ought 
to  be  the  most  vigorous  and  healthy  of  any. 

At    this    time    the    great   demands    on 


Dissipation  ajid  Co7iswnptio7i  77 

the  system  for  growth  and  development 
are  on  the  wane,  the  debilitating  diseases 
of  childhood  are  over,  the  circulation  is 
strong  and  vigorous, — reaching  out  into 
ever}'  part  of  the  body,  coloring  it  with 
beauty  and  health, — and  the  ambitions 
and  hopes  of  life  have  not  yet  had 
the  first  frost  of  disappointment.  Ever}'- 
thing  so  far  as  nature  itself  is  concerned 
makes  for  health  and  militates  against 
consumption. 

The  rapid  increase  in  the  disease  during 
this  epoch  can  be  accounted  for  only  on 
the  basis  of  exhaustion  of  the  nervous  sys- 
tem through  dissipations  of  youth. 

Dissipations  of  later  life,  which  pre- 
dispose to  consumption,  are  excess  in 
eating,  in  drinking,  and  in  the  use  of 
tobacco.  I\Iost  people  have  the  impres- 
sion that  bii^  eating"  and  drinkincr — a  red 
face  and  a  fat  belly  —  give  protection 
against  consumption.  This  is  a  great  fal- 
lacy. 


-^ 


78  Crusade  against  Tuberculosis 

Malnutrition  of  any  kind  predisposes  to 
tuberculosis,  A  florid  complexion,  the 
result  of  dilated  blood-vessels,  and  an  ex- 
cess of  fat  in  the  abdomen  are  signs  of 
degeneration  and  not  of  health. 

A  certain  amount  of  embonpoint,  after 
forty,  is  natural.  It  must  not  be  looked 
upon  as  a  bulwark  against  tuberculosis, 
however. 

A  florid  complexion  likewise  is  normal 
for  some  people,  but  when  the  entire  skin 
is  reddened  there  is  a  paralysis  of  the 
blood-vessels  which  usually  has  been 
caused  by  food  and  drink. 

Excess  in  eating  and  drinking  puts  a 
burden  on  the  digestive  system  and  the 
excretory  system  which  sooner  or  later 
incapacitates  them.  Then  begins  an  inter- 
ference with  normal  action  in  organs  of 
the  body,  and  gradually  the  organism 
loses  its  power  of  self-protection  against 
invading  disease  germs. 

Excessive  use  of  tobacco  may  predis- 


Dissipation  and  Consumption  79 

pose  to  tuberculosis  by  weakening  the 
heart.  A  good  vigorous  heart-action  is 
of  great  value  in  maintaining  a  normal 
standard  of  health,  and  normal  health  is 
the  best  bulwark  against  tuberculosis. 


CHAPTER  XII 

Want  as   a   Predisposing 
Cause   of  Con- 
sumption 

CONSUMPTION  is  largely  a  disease  of 
the  poor.  The  conditions  for  implantation 
are  best  among  the  poor  and  there  is  good 
soil  for  growth  and  development. 

The  poor  live  in  small  badly  ventilated 
houses  on  small  badly  ventilated  streets. 
Frequently  they  live  in  what  are  called 
blind  alleys;  that  is,  streets  with  only  one 
outlet.  Sunshine  and  fresh  air  are  stran- 
gers to  such  houses. 

A  house  with  little  sunshine  and  fresh 
air  easily  becomes  contaminated  with  tuber- 
cular matter.  It  serves  as  a  granary  for 
the  tubercle  bacillus.  Everyone  who  lives 
in    such   a   house,   after  contamination,   is 

80 


Want  and  Consumption  8 1 

liable  to  get  an  implantation  of  the  tubercle 
bacillus. 

When  consumption  gets  into  a  poverty- 
stricken  family  every  member  is  doomed  to 
get  an  implantation.  Some  recover  without 
the  disease  being  discovered,  some  strug- 
gle a  lifetime  with  the  disease  under  an 
alias,  and  the  rest  die  of  consumption. 
Frequently  the  whole  family  dies  of  the 
disease. 

The  conditions  under  which  the  poor  live 
are  conducive  to  consumption.  Old,  filthy 
carpets  remain  on  the  floor  for  years  with- 
out being  cleaned.  The  paper  on  the  walls 
hangs  in  shreds.  Window  hangings  shut 
out  the  air  and  light  in  exactly  the  same 
way  day  in  and  day  out,  year  in  and  year 
out.  The  esthetic  instinct  lies  vanquished 
at  the  feet  of  poverty,  and  disease  ravishes 
the  household. 

Probably  fifty  per  cent,  of  the  houses  of 
the  poor  are  contaminated  with  tubercular 
matter.     In  many  instances  the  contamina- 


82  Crusade  against  Tuberculosis 

tion  is  intense  enough  to  give  implantations 
for  years. 

The  consumptive  poor  often  move  be- 
cause they  cannot  pay  rent.  Every  house 
from  which  a  poor  consumptive  moves 
is  left  contaminated. 

Some  member  of  the  family  moving  in 
is  sure  to  get  an  implantation.  Usually  it 
is  the  person  who  occupies  the  room  which 
had  been  occupied  by  the  last  consumptive. 

The  personal  habits  of  the  poor  facilitate 
implantation  of  the  tubercle  bacillus.  Use  of 
the  kitchen  as  a  dining-room,  sitting-room, 
parlor,  and  sick-room,  eating  with  un- 
washed hands,  and  use  of  the  same  eating 
utensils  in  common,  help  the  tubercle  bacil- 
lus, if  it  is  in  the  household,  to  get  into  a 
new  host. 

Malnutrition  favors  implantation  of  the 
tubercle  bacillus  and  development  of  tuber- 
culosis. The  poor,  as  a  rule,  are  badly 
nourished.  They  spend  their  meagre  in- 
comes on  food  which  tickles  the  palate  and 


Want  and  Consumption  83 

starves  the  body.  Often  they  spend  much 
on  stimulants  to  quiet  their  complaining 
nerves. 

Ignorance  of  the  nutritive  value  of  food 
and  lack  of  training  in  the  preparation  of 
food  are  responsible  for  this. 

Want,  in  the  restricted  sense  of  depriva- 
tion of  the  necessities  of  life,  prepares  the 
way  for  consumption  by  taking  from  the 
individual  his  resisting  power  to  disease. 
It  not  only  invites  implantation  but  favors 
growth  and  development.  It  makes  rich 
soil  in  which  growth  is  luxurious  and  crops 
mature  rapidly. 

Starvation  is  so  like  tuberculosis  in  its 
effect  as  to  be  indistinguishable  from  it  upon 
casual  observation.  Both  emaciate  the 
body  to  an  extreme  degree. 

In  practical  life  there  is  great  affinity  be- 
tween starvation  and  tuberculosis.  They 
pass  through  the  world  in  their  work  of 
devastation  linked  arm  in  arm  when  pos- 
sible, and  when  separated  strive  to  come 


84  Crusade  against  Tuberculosis 

together  by  preparing  the  way  for  each 
other.  In  viewing  the  ruins  it  is  hard  to 
say  how  much  was  done  by  the  one  and 
how  much  by  the  other. 

Insufficient  clothing  reduces  the  resisting 
power  of  the  body  to  disease  by  diverting 
an  excessive  amount  of  vital  force  to  heat- 
making  purposes.  Food  is  largely  used  up 
for  heat,  leaving  very  little  for  other  de- 
mands of  the  organism. 

In  olden  times  it  was  believed  that  in- 
sufficient clothing  was  the  real  cause  of 
consumption.  This  led  to  the  practice  of 
'^ bundling  up"  and  "housing  closely"  on 
the  part  of  those  who  could  afford  it,  and 
gave  rise  to  a  new  predisposing  cause  of 
consumption. 

Insufficient  shelter  only  becomes  a  pre- 
disposing cause  of  consumption  inasmuch 
as  it  makes  people  shut  themselves  up  in 
close  rooms  to  keep  themselves  warm. 
Outdoor  life  gives  protection  against  tuber- 
culosis no  matter  how  cold  the  weather 
may  be. 


CHAPTER  XIII 

Overwork   as   a 

Predisposing  Cause   of 

Consumption 

WHEN  the  living  body  is  in  a  perfect  state 
of  health  and  all  its  machinery  is  running 
at  a  normal  rate  of  speed,  it  has  great  power 
of  destroying  disease  germs  by  its  own 
fluids.  This  power  is  called  phagocytosis. 
Phagocytism  exists  in  the  blood.  Ex- 
actly what  constitutes  it  we  do  not  know. 
The  literal  meaning  of  the  word  is  "eating 

a  cell." 

The  blood  is  a  composite  substance  con- 
taining many  important  elements.  One  of 
these,  the  white  corpuscle,  displays  a  pro- 
pensity for  eating  cells,  and  is  credited  with 
the  power  of  destroying  disease  germs. 

The  probabilities  are  that  phagocytism 

85 


S6  Crusade  against  Tuberculosis 

depends  upon  more  than  one  element  of  the 
blood.  In  practical  life  it  is  best  where  the 
blood  is  most  perfect. 

Blood-making  is  a  very  complex  process. 
Almost  eveiy  organ  of  the  body  enters  into 
it.  Practically  all  the  internal  secretions 
of  the  body  are  poured  into  the  blood. 
Excessive  use  of  one  organ  or  department 
of  the  body  therefore  may  interfere  readily 
with  blood-making. 

A  common  cause  of  disturbance  of 
phagocytism  is  fatigue.  Overwork  probably 
interferes  with  the  blood-making  process  by 
diverting  too  much  energy  from  the  organs 
concerned  in  it.  Every  individual  has  his 
limitations  in  the  production  of  energy. 

When  a  person  uses  more  than  the 
normal  proportion  of  energy  for  one  pur- 
pose, functions  which  cannot  be  suspended 
may  be  imperfectly  performed  on  account 
of  deprivation.  Blood-making  is  a  constant 
function,  which  cannot  be  stopped  without 
prejudice. 


Overwork  a7id  Consumption  87 

Probably  all  diseases  are  more  readily- 
contracted  after  fatigue  than  at  any  other 
time.  Some  show  a  marked  propensity  this 
way.  Pneumonia  is  almost  always  con- 
tracted after  fatigue. 

Colds  usually  first  manifest  themselves 
after  fatigue.  A  person  gets  very  tired  and 
sits  down  to  rest.  By  and  by  he  feels 
chilly  and  stuffed.  He  looks  around  and 
sees  an  open  window  or  door,  or  finds  him- 
self in  the  open.  He  concludes  that  he  has 
taken  cold  from  sitting  in  a  draught  or  from 
exposure.  In  reality  the  disease  existed 
before  the  fatigue,  but  in  an  undeveloped 
state  and  was  fanned  into  activity  by  it. 

Consumption  is  much  influenced  by  fa- 
tigue, but  not  in  a  way  easily  discerned. 
Cause  and  effect  follow  each  other  so  far 
apart  in  consumption  and  in  such  a  crowd 
of  influences  that  their  relationship  is  not 
manifest. 

The  human  body  ordinarily  cannot  make 
enough  energy  to  supply  the  demands  of 


88  Crusade  against  Tuberculosis 

occupation  and  disease  at  the  same  time. 
In  tuberculosis,  however,  it  can  make 
enough  to  keep  the  disease  at  bay  for  a 
long  time  during  occupation  and  sometimes 
to  fight  it  to  a  finish.  There  is  a  strong 
tendency  toward  recovery  in  tuberculosis. 

Implantation  of  the  tubercle  bacillus  is 
facilitated  by  fatigue.  This  explains  why  of 
two  persons  apparently  with  the  same  pro- 
pensities and  under  the  same  environments 
one  takes  the  disease  and  the  other  does 
not. 

In  the  development  of  tuberculosis  fatigue 
is  a  potent  factor.  When  people  are  sick 
with  acute  diseases,  they  go  to  bed  in  order 
to  give  their  bodies  every  chance  of  throw- 
ing off  the  disease.  When  they  have  tuber- 
culosis, they  work  as  usual. 

Ovenvork  usually  helps  to  mature  the 
earher  implantations  of  the  tubercle  bacil- 
lus. A  person  has  a  very  small  crop  of  tu- 
bercle bacilli  growing  in  the  apex  of  one 
lung.    It  attracts  no  attention.    He  fatigues 


Overwork  and  Consumption  89 

himself  unduly  and  has  a  slight  breakdown 
for  a  week  or  two. 

The  breakdown  is  called  a  cold  by  the 
patient  and  his  friends  and  perhaps  by 
his  doctor.  In  reality  it  is  the  harvest  of 
one  crop  of  tubercle  bacilli  and  the  seed- 
scattering  of  another  and  larger  one.  Over- 
work was  the  sunshine  which  ripened  the 
crop. 

As  tuberculosis  grows  and  develops  into 
consumption  fatigue  becomes  a  powerful 
factor  in  the  work  of  destruction.  It  is  the 
night  shift,  so  to  speak.  It  makes  the  on- 
slaught upon  the  vitality  of  the  individual 
continuous.  What  the  disease  does  not  ac- 
complish fatigue  does. 

Overwork  is  largely  responsible  for  the 
high  death-rate  from  consumption.  The 
poor  work  until  they  drop  in  their  tracks. 
The  part  played  by  fatigue  does  not  appear 
in  the  mortality  statistics,  however. 


CHAPTER  XIV 

Alcohol   as   a   Predisposing 
Cause   of  Con- 
sumption 

THERE  is  a  popular  idea  that  alcohol  is 
a  preventive  of  consumption.  In  America 
and  England  whiskey  is  the  beverage 
credited  with  such  powers,  in  France  wine, 
and  in  Germany  beer. 

It  would  be  interesting  to  know  how  this 
idea  originated.  Usually  popular  ideas, 
even  when  false,  contain  a  germ  of  truth. 

A  moderate  use  of  alcohol  stimulates 
nutrition.  It  gives  a  ruddy  complexion  and 
a  round  form.  These  stand  out  in  strong 
contrast  with  the  pale  face  and  emaciated 
form  of  the  consumptive. 

The  popular  mind  jumps  at  conclusions. 
It  sees  the  ruddy  round  form  and  it  sees 

90 


Alcohol  and  Consumption  9 1 

the  pale  emaciated  form.  Because  it  as- 
sociates the  one  with  the  use  of  alcohol,  it 
associates  the  other  with  the  want  of  it. 

Theoretically,  it  may  be  true  that  alco- 
hol prevents  consumption.  Healthy  nu- 
trition prevents  consumption,  and  within 
certain  limits  alcohol  stimulates  nutrition. 
Herein  no  doubt  lies  the  germ  of  truth. 

The  amount  of  alcohol  which  can  be 
taken  within  limits  of  stimulation  of  nutri- 
tion is  exceedingly  small,  however.  In 
practical  life  it  seldom  is  adhered  to. 

When  a  larger  amount  of  alcohol  is  taken 
than  can  be  appropriated  advantageously 
by  the  system,  it  becomes  an  irritant  and  a 
check  upon  nutrition.  Malnutrition  may 
exist  even  with  a  ruddy  face  and  a  round 
form. 

Few  limit  themselves  to  the  amount  of 
alcohol  which  can  be  taken  within  bounds 
of  good  health.  One  readily  acquires  a 
habit  of  taking  a  beverage  and  soon  culti- 
vates an  appetite  for  it.  Habit  and  appe- 
tite lead  to  excess. 


92  Crusade  against  Tuberculosis 

When  people  drink  alcoholic  beverages 
they  do  so  to  quench  thirst,  to  satisfy  a 
craving,  or  for  the  sake  of  good  fellowship. 
In  any  event  they  do  not  regulate  the  bev- 
erage by  the  alcohol  but  by  the  incentive. 
Usually  they  get  enough  alcohol  to  poison 
themselves. 

Alcohol  in  poisonous  doses  gradually 
brings  about  changes  in  the  liver  and  kid- 
neys. These  organs  apparently  become 
martyrs  to  duty.  They  try  to  protect  the 
system  against  the  evil  influence  of  the  al- 
cohol and  wear  out  in  so  doing. 

Excessive  labor  of  the  liver  and  kidneys 
throws  an  undue  burden  upon  the  heart  and 
blood-vessels,  which  ultimately  leads  to  in- 
jury. Finally,  when  the  pump  and  pipe 
lines  have  been  damaged,  the  whole  organ- 
ism is  at  a  disadvantage  in  fighting  disease. 

At  first  the  heart  muscles  enlarge,  then 
degenerate  and  stretch.  The  blood-vessels 
thicken.  With  obstruction  in  front  and 
weakness  behind  the  whole  body  becomes 


Alcohol  and  Consti7nptio7t  93 

water-logged  with  blood.  The  lungs  suffer 
even  more  than  the  rest  of  the  body  be- 
cause of  the  double  circulation  which  passes 
through  them. 

Slow  stagnant  circulation  is  conducive  to 
implantation  and  growth  of  the  tubercle 
bacillus.  An  organ  which  has  been  injured 
by  violence  or  disease  is  prone,  on  this 
account,  to  tuberculosis.  For  the  same 
reason  tuberculosis  usually  begins  in  the 
upper  part  of  the  lungs. 

When  a  family  is  exposed  to  tuberculosis 
the  members  who  use  alcohol  to  excess  are 
among  the  first  to  contract  the  disease. 
Bar-tenders  frequently  are  victims  of  tuber- 
culosis. 

Among  the  poor  alcoholism  and  tuber- 
culosis are  seen  hand  in  hand  as  boon  com- 
panions in  their  work  of  destruction.  In 
France  alcoholism  is  looked  upon  as  the 
most  potent  factor  in  the  spread  of  tuber- 
culosis. 

The  coincidence  of  alcoholism  and  tuber- 


94  Crusade  against  Tuberculosis 

culosis  does  not  necessarily  prove  that  al- 
cohol is  a  predisposing  cause  of  consump- 
tion, but  it  does  prove  that  it  is  not  a  pre- 
ventive. It  may  be  that  the  filthy  habits 
and  bad  environments  which  go  with  alco- 
holism lead  to  implantation  of  the  tubercle 
bacillus.  The  fact  remains,  however,  that 
an  alcoholic  is  more  likely  to  get  tubercu- 
losis than  a  nonalcoholic. 

Alcoholism  in  the  parent  appears  to  pro- 
duce a  predisposition  to  tuberculosis  in  the 
offspring.  This  is  in  line  with  a  general 
principle,  however,  which  does  not  apply  to 
tuberculosis  alone.  Alcoholism  in  the  par- 
ent leads  to  degeneracy  in  the  offspring. 
Degeneracy  paves  the  way  for  all  kinds  of 
diseases. 

Alcoholism  helps  tuberculosis  in  its 
work  of  destruction.  An  alcoholic  with  tu- 
berculosis is  more  difficult  to  treat  than  a 
nonalcoholic.  Unless  he  stops  the  alcohol 
there  is  no  hope  for  him. 


CHAPTER   XV 

Climate  as  a  factor  in 
Consumption 

HIPPOCRATES,  five  hundred  years  be- 
fore Christ,  taught  that  consumption  was  a 
weather  disease.  Wet  seasons,  damp  winds, 
and  sudden  changes  in  temperature  were 
blamed.  Hippocrates  reflected  the  views 
of  the  ages  before  him. 

The  world  still  believes  much  of  what  Hip- 
pocrates taught.  With  most  people  climate 
is  the  chief  factor  in  consumption.  ''Oh,  this 
beastly  climate  !"  is  on  the  lips  of  the  con- 
sumptive and  his  friends  wherever  you  go. 

In  cold  climates  it  is  the  low  temperature 
which  specifically  is  blamed,  in  damp  cli- 
mates it  is  the  moisture,  in  high  dry  climates 
it  is  the  dusty  winds  and  great  variation  of 
temperature  between  night  and  day,  and  in 
warm  climates  it  is  the  terrible  heat. 

95 


96  Crusade  against  Tuberculosis 

There  is  no  place  in  the  world  which  has 
withstood  the  inroads  of  consumption. 
Countries  which  were  free  when  first  visited 
by  civilization  soon  developed  a  fine  crop 
after  the  disease  had  been  introduced. 

Of  the  newer  countries  many  are  known 

to  have  been  free  from  consumption  when 

discovered.     The  Bermudas,  America,  and 

the  Sandwich   Islands  were  strangers  to  it 

until  visited  by  civilization. 

The  Bermudas  have  an  even  climate. 
Consumption    came    with    the    Europeans, 

soon  became  rampant  and  wiped  out  the 

natives. 

New  York  at  one  time  was  a  health  resort 
for  consumptives;  so  was  Pennsylvania  and 
so  was  every  State  in  the  Union  in  turn  and 
in  order  going  west.  The  reputation  earned 
in  the  primeval  forest  was  lost  in  the  culti- 
vated fields.  When  consumption  became 
prevalent,  it  was  said  that  the  climates  had 
changed. 

The  American  Indian  had  been  free  from 


Climate  and  Consumption  97 

consumption  up  until  the  time  when  he  met 
the  European  consumptive.  Contact  was 
fatal  to  him.  He  developed  consumption 
in  the  most  malignant  form  and  was  ex- 
terminated. 

The  Hawaiians  were  free  from  consump- 
tion when  first  visited  by  missionaries.  They 
had  colds  and  coughs  but  no  consumption. 
Their  delightful  climate  attracted  the  con- 
sumptive. Now  they  are  decimated  by  the 
disease. 

The  United  States  census  report  of  1900 
shows  the  highest  mortality  from  consump- 
tion to  exist  in  the  finest  climates.  Cali- 
fornia, Arizona,  Oregon,  Nevada,  Colorado, 
South  Dakota,  Kentucky,  Tennessee,  Vir- 
ginia, North  Carolina,  and  South  Carolina 
are  the  banner  States  of  the  disease.  As  a 
matter  of  course,  many  of  the  deaths  in 
these  States  are  of  health-seekers. 

In  analyzing  the  influence  of  climate 
upon  consumption  it  is  necessary  to  keep  in 

mind  the  complex  nature  of  consumption. 

7 


98  Crusade  against  Tuberculosis 

The  tubercle  bacillus,  the  streptococcus, 
and  the  staphylococcus  each  has  an  indi- 
viduality, and  all  of  them  are  influenced 
more  or  less  by  such  micro-organisms  as 
the  pneumo coccus,  the  influenza  bacillus, 
and  the  cold  micro-organisms. 

On  account  of  the  relationship  between 
the  tubercle  bacillus  and  other  micro- 
organisms the  prevalency  of  consumption 
in  a  place  depends  somewhat  upon  the 
prevalency  of  other  diseases.  In  conse- 
quence of  this  in  some  climates  tuberculosis 
may  not  develop  into  consumption  as  read- 
ily as  in  others. 

The  tubercle  bacillus  can  be  implanted 
in  any  climate  known  to  man.  Appar- 
ently also  it  grows  and  forms  tuberculosis 
in  any  climate. 

Some  climates,  however,  seem  to  be  less 
favorable  than  others  for  the  implantation 
and  growth  of  the  streptococcus  and  staphy- 
lococcus. Tuberculosis,  therefore,  is  less 
prone  to  change  into  consumption  in  such 


Climate  and  Consumption  99 

climates,  and  accordingly  there  is  a  greater 
tendency  toward  recovery. 

In  mild  climates  in  which  there  is  a  great 
deal  of  sunshine  the  tubercle  bacillus  also 
has  less  chance  of  entering  a  new  host  after 
leaving  its  old  host  than  in  cold  climates 
with  little  sunshine.  Outdoor  life  and  sun- 
shine are  enemies  of  the  tubercle  bacillus. 
There  is  less  contagion  therefore. 

Strictly  speaking  climate  has  no  causa- 
tive relationship  to  consumption.  It  in- 
fluences the  disease  only  in  so  far  as  it 
affects  the  micro-organisms  which  have  to 
do  with  the  disease. 

In  a  general  way  cold  dry  climates  are 
less  conducive  to  the  prosperity  of  the 
micro-organisms  which  have  to  do  with 
consumption  than  are  moist  warm  climates. 
Consumption  usually  runs  a  more  rapid 
course  in  warm  climates  than  in  cold 
climates. 


CHAPTER  XVI 

Immunity  from  Tuber- 
culosis 

THERE  is  an  inherent  law  of  antagonism 
in  organic  nature  by  which  the  existing 
state  of  things  is  preserved.  Every  living 
thing  is  in  a  sense  parasitic  and  in  turn  is 
preyed  upon.  In  the  interest  of  equili- 
brium all  life  has  been  endowed  with  a 
sense  of  self-preservation  and  powers  of 
self-protection. 

Man  is  the  prey  of  many  kinds  of  para- 
sites. He  has,  however,  within  himself 
ample  resources  of  warfare  against  destruc- 
tion by  them. 

When  the  human  system  has  waged  war 
against  a  parasite  and  has  won  the  battle, 
a  condition  usually  arises  under  which  the 

lOO 


Immunity  from   Tuberculosis  loi 


same  parasite  cannot  again  take  up  arms 
against  it  for  a  longer  or  shorter  period  of 
time.     This  is  called  immunity. 

How  immunity  is  brought  about  we  do 
not  know.  Some  claim  that  it  is  by  a  high 
development  of  phagocytosis  or  disease- 
fighting  power.  Others  that  it  is  by  an 
exhaustion  of  soil  upon  which  the  parasite 
feeds. 

In  a  way  immunity  is  the  antithesis  of 
predisposition.  It  is  the  negative  pole  of 
an  organism  toward  disease  where  predis- 
position is  the  positive  pole. 

Immunity  varies  in  quantity  and  quality. 
It  may  be  so  full  and  complete  as  to  give 
absolute  protection  under  the  most  intense 
exposure,  and  it  may  shade  down  from  this 
to  such  a  small  quantity  as  to  merely 
modify  the  disease  instead  of  protecting 
against  it.  Incomplete  immunity  is  illus- 
trated in  varioloid. 

The  quality  of  immunity  is  shown  by  its 
endurance.     Immunity  is  perfect  when  it  is 


I02         Crusade  against  Tuberculosis 

absolute  for  life.  It  shades  from  this  to 
mere  partial  protection  for  a  comparatively 
short  period  of  time.  The  immunity  which 
sometimes  is  conferred  by  smallpox  is  an 
illustration  of  perfect  immunity. 

Immunity  may  be  acquired  by  an  indi- 
vidual, by  a  family,  and  by  a  race.  Indi- 
vidual immunity  always  is  obtained  through 
a  personal  struggle  against  a  disease.  It  is 
the  only  form  of  immunity  which  ever  is 
perfect  and  complete. 

Family  immunity  is  the  result  of  the  pro- 
longed struggle  of  a  family  against  a  dis- 
ease for  several  generations.  As  a  rule  it 
is  imperfect  and  incomplete,  but  at  times  it 
is  absolute.  It  can  be  transmitted  from 
parent  to  offspring. 

Racial  immunity  is  the  aggregation  of 
family  immunity  of  an  entire  people.  It 
always  is  incomplete.  It  modifies  a  disease 
but  does  not  give  protection  against  it. 

Acute  diseases,  which  affect  the  entire 
body    at   once,    give   the    best   and   most 


Immunity  from   Tuberctdosts  103 

complete  immunity.  Smallpox,  measles, 
scarlet  fever,  and  typhoid  fever  are  good 
examples  of  diseases  which  give  complete 
immunity.  Acute  diseases,  however,  ap- 
parently do  not  produce  family  and  racial 
immunity  in  the  same  degree  as  do  chronic 
diseases. 

Chronic  diseases,  which  affect  only  a 
part  of  the  body  at  one  time,  and  which 
gradually  extend  their  devastation  until 
finally  they  have  damaged  the  entire  or- 
ganism, usually  kill  before  they  can  produce 
perfect  immunity.  Consumption  and  cancer 
are  examples  of  such  diseases.  Chronic 
diseases  have  a  stronger  tendency  to  pro- 
duce family  and  racial  immunity  than  have 
acute  diseases. 

Tuberculosis  seldom  gives  rise  to  com- 
plete perfect  individual  immunity.  It  may 
produce  an  immunity  strong  enough,  how- 
ever, to  protect  against  subsequent  attacks 
under  ordinary  exposure.  Persons  who 
have  recovered  from  tuberculosis  appear  to 


104  Crusade  against  Tuberculosis 

be  less  susceptible  to  the  disease  than  per- 
sons who  have  not  had  it. 

Family  immunity  against  tuberculosis  is 
of  common  occurrence.  It  is  produced  hy 
a  prolonged  struggle  against  the  disease 
through  several  generations. 

Parents  who  have  had  tuberculosis  and 
have  recovered  from  it  or  who  have  tu- 
berculosis at  the  time  of  procreation  ap- 
parently transmit  a  partial  immunit}'  to 
their  offspring.  If  the  offspring  gets  tuber- 
culosis, it  will  be  in  milder  form  than  the 
parents  had  it. 

Such  offspring  if  it  has  had  tuberculosis 
and  has  recovered  from  it  or  if  it  is  tuber- 
cular before  or  at  the  time  of  procreation 
may  in  turn  transmit  a  better  immunity 
than  did  its  parents.  Ultimately  by  a  con- 
tinuance of  the  process  immunity  becomes 
complete  and  perfect. 

Family  immunit}'  against  tuberculosis 
when  once  acquired  may  be  transmitted  to 
offspring,   but  is  not  permanent.     It  may 


Immunity  from   Tuberculosis  105 

last  for  several  generations,  however.  Its 
instability  gave  tuberculosis  the  classical 
reputation  of  skipping  a  generation  or  two 
occasionally  in  a  family  and  then  re- 
appearing. 

Racial  immunity  from  tuberculosis  is 
found  among  many  peoples,  and  can  be 
demonstrated  by  the  aid  of  history.  The 
Jews  have  the  best  immunity.  Among 
the  Gentiles,  the  Greeks,  the  Latins,  the 
Teutons,  and  the  Celts  follow  each  other  in 
respective  order. 

The  Jews,  of  all  people  known,  are  least 
prone  to  tuberculosis  and  recover  most 
readily  when  they  have  it.  They  probably 
have  been  exposed  to  the  disease  longest 
of  any  people  known.  They  have  fought 
the  disease  longest  and  have  developed 
most  resisting  power.  Their  immunity, 
however,  is  neither  perfect  nor  complete. 

As  compared  with  newer  races  the  Euro- 
peans show  some  immunity  from  tuber- 
culosis.     The     Spaniards,     Italians,     and 


io6  Crusade  against  Tuberculosis 

French  have  the  best,  and  the  English, 
German,  and  Irish  follow  in  the  order 
named. 

The  races  which  have  been  exposed  to 
tuberculosis  for  a  comparatively  brief  period 
of  time  have  very  little  resisting  power  to 
the  disease.  The  Am.erican  Indian  was 
wiped  out  before  he  could  develop  an  im- 
munity. The  American  colored  man  is 
three  times  more  susceptible  to  the  disease 
than  his  white  brother. 

In  the  interior  ot  Africa  tuberculosis  is 
said  to  be  still  unknown.  The  African 
when  he  comes  to  countries  in  which  tuber- 
culosis exists,  however,  shows  a  very  great 
susceptibility  to  the  disease,  and  gets  it  in 
malignant  form.  As  compared  with  him 
the  American  negro  has  developed  some 
immunity  in  the  time  during  which  he  has 
struggled  against  the  disease. 

In  the  concrete,  immunity  from  tubercu- 
losis is  hard  to  demonstrate,  because  of  the 
universality  of  the  disease  and  the  many 


Immunity  fro7n   Tuberculosis  107 

influences  which  enter  into  its  development. 
It  can  only  be  recognized  when  the  disease 
is  studied  in  a  broad  historical  way. 

In  the  abstract,  however,  immunity  from 
tuberculosis  is  easily  proven.  The  exist- 
ence of  the  human  race  proves  it.  Tuber- 
culosis is  universal  and  it  is  contagious. 
It  has  existed  for  ages.  There  must  have 
been  a  saving  power  somewhere  or  the 
whole  human  race  would  have  been  wiped 
out  before  now.  Immunity  has  saved  the 
human  race. 


CHAPTER  XVII 

Tuberculosis  is  Con- 
tagious 

ALL  diseases  which  are  due  to  a  living 
organism  are  communicable.  They  cannot 
arise  except  by  communication. 

Micro-organisms  are  living  things.  No 
living  thing  can  come  into  existence  except 
through  a  living  thing  of  its  kind.  Life 
begets  life. 

Communicable  diseases  are  subdivided 
into  contagious  and  infectious.  This  sub- 
division tells  something  of  the  life  history 
of  the  micro-organisms  and  hints  at  the 
proper  methods  of  prevention. 

Micro-organisms  which  ordinarily  do  not 
multiply  outside  of  a  host  must  go  directly 
from  one  host  to  another.     Diseases  pro- 

io8 


Tuberculosis  is  Contagious  109 

duced  by  such  micro-organisms  are  called 
contagious. 

Micro-organisms  which  multiply  outside 
of  a  host  or  which  have  two  kinds  of  hosts 
for  different  periods  of  their  existence  may 
go  from  one  host  to  another  in  a  very 
roundabout  way.  Diseases  produced  by 
such  micro-organisms  are  called  infectious. 

The  word  contagious  is  derived  from  a 
Latin  word,  "  contingere  " — to  be  in  con- 
tact with.  The  word  infectious  is  derived 
from  the  Latin  words  *'in"  and  "facere" 
to  put  in  or  make  in. 

With  contagious  diseases  there  must  be 
contact  between  the  person  giving  off  the 
disease  and  the  person  getting  it.  This 
contact  may  be  direct  or  indirect. 

It  is  direct  when  the  person  getting  the 
disease  is  in  contact  with  the  person  giving 
it  off.  It  is  indirect  when  the  person  get- 
ting the  disease  is  in  contact  with  a  place 
or  thing  which  has  been  in  contact  with  the 
person  giving  it  off. 


no  Crusade  against  Tuberculosis 

With  contagious  diseases  the  force  re- 
quired for  conveying  micro-organisms  from 
one  to  another  must  be  generated  by  the 
two  persons  concerned.  One  ejects  them 
and  the  other  inhales  them  or  carries  them 
into  his  stomach  with  his  food.  The  two 
persons  must  be  close  together. 

With  infectious  diseases  the  contact  be- 
tween the  person  giving  off  the  micro- 
organisms and  the  person  getting  them  is 
unnecessary.  They  may  be  many  miles 
apart. 

The  force  required  for  conveying  micro- 
organisms from  one  to  another  with  infec- 
tious diseases  is  generated  in  part  at  least, 
and  in  some  instances  entirely,  outside  of 
the  two  persons  concerned.  It  may  be  a 
force  in  nature  such  as  water  or  it  may  be 
generated  by  some  other  living  thing,  such 
as  a  mosquito,  which  acts  as  an  intermedi- 
ary host. 

Smallpox,    measles,    and    scarlet    fever 
usually  are  given  as  types  of  contagious  dis- 


Tuberculosis  is  Contagious  1 1 1 


eases.  Yellow  fever,  malaria,  and  typhoid 
fever  are  looked  upon  as  types  of  infectious 
diseases. 

With  smallpox,  measles,  and  scarlet 
fever  the  micro-organisms  are  given  off  by 
the  skin,  and  probably  by  the  secretory  and 
excretory  organs.  In  order  to  get  the 
micro-organisms  which  produce  these  dis- 
eases one  must  go  to  the  place  where  they 
are  given  off,  or  have  something  brought 
to  him  from  the  place. 

With  yellow  fever  and  malaria  the  micro- 
organisms are  not  given  off  at  all.  They 
are  taken  out  of  one  host,  carried  to  an- 
other and  put  into  him  by  a  mosquito. 

With  typhoid  fever  the  micro-organism 
is  carried  from  one  host  to  another  by 
water.  Typhoid  fever  is  not  a  typically  in- 
fectious disease.  It  partakes  somewhat  of 
the  nature  of  a  contagious  disease. 

Tuberculosis  is  typically  a  contagious 
disease.      It  is  always  and  only  a  contact 


112  Crusade  against  Tuberculosis 

disease.  It  cannot  be  conveyed  except  by 
contact. 

The  tubercle  bacillus  ordinarily  does  not 
multiply  outside  of  a  host.  Its  cycle  of 
life  is  in  suspense  from  the  time  it  leaves 
one  host  until  it  enters  another. 

It  has  no  powers  of  locomotion.  It  is 
not  conveyed  from  one  person  to  another 
by  water  nor  by  an  intermediary  host. 

It  lies  on  the  spot  where  it  lodges  when 
ejected  from  an  old  host  until  some  extra- 
neous force  moves  it.  The  forces  in  nature 
which  can  move  it,  such  as  air  and  water, 
are  destructive  of  its  life. 

The  only  way  in  which  it  can  be  moved 
without  prejudice  is  by  being  carried  on 
something  on  which  it  lodged,  when  expec- 
torated. This  is  often  done  and  constitutes 
one  form  of  indirect  contact.  Such  things 
are  called  fomites. 

Ordinarily  the  new  host  must  come  to 
the  place  where  it  is  ejected.  When  this 
happens  during  the  lifetime  of  the  old  host 


Tuberculosis  is  Contagious  1 1 3 

it  constitutes  direct  contact.  When  it 
happens  after  the  death  of  the  old  host  it 
is  another  form  of  indirect  contact. 

Contact  with  the  person  who  has  con- 
sumption, contact  with  the  place  which 
has  been  occupied  by  a  consumptive,  and 
contact  with  a  thing  which  has  been  used 
by  a  consumptive  are  the  three  methods 
by  which  tuberculosis  is  contracted.  The 
first  probably  gives  two-thirds  of  all  im- 
plantations, the  second  two-thirds  of  the 
remaining  third  and  the  last  the  balance. 

For  implantation  of  the  tubercle  bacillus 
contact  with  a  person,  place,  or  thing 
capable  of  conveying  the  disease  must  be 
intimate  and  prolonged.  Casual  contact 
proves  sterile. 

The  contagiousness  of  tuberculosis  dif- 
fers from  the  contagiousness  of  such  dis- 
eases as  smallpox,  measles,  and  scarlet 
fever  in  rapidity  of  action  and  in  intensity. 
In  everything  else  it  is  the  same.  In  small- 
pox, measles,  and  scarlet  fever  contagion  is 


114  Crusade  against  Tuberculosis 

given  off  by  the  entire  body.  Places  and 
things  are  therefore  quickly  contaminated. 
In  tuberculosis  contagion  usually  is  given 
off  by  one  part  of  the  body  only.  Con- 
tamination therefore  is  slow. 

Momentary  contact  with  a  person  suf- 
ering  from  smallpox,  measles,  or  scarlet 
fever  or  with  a  place  or  thing  which 
has  been  in  contact  with  such  a  person 
may  convey  the  disease.  It  requires 
prolonged  contact  to   convey  tuberculosis. 

Smallpox,  measles,  and  scarlet  fever 
are  contagious  from  the  time  they  begin 
until  the  injured  skin  has  completely 
peeled  off  and  become  natural  again. 
Tuberculosis  is  not  contagious  before  there 
is  spitting  up  or  formation  of  matter  and 
may  be  non-contagious  at  any  time  during 
the  disease  when  there  is  no   spitting   up 

nor  pus-formation. 

With  smallpox,  measles,  and  scarlet  fever 
it  is  impossible  to  collect  and  sterilize  all  the 
matter  which  contains  the  micro-organisms. 


Tuberculosis  is  Contagious  1 1 5 

With  tuberculosis  every  particle  of  matter 
which  contains  micro-organisms  can  be  con- 
trolled and  sterilized. 

With  smallpox,  measles,  and  scarlet  fever 
it  is  impracticable  to  make  the  persons  suf- 
fering from  the  disease  innocuous  to  others 
without  isolation.  With  tuberculosis  the 
patient  can  be  made  harmless  to  others  even 
under  the  most  intimate  family  relations. 


CHAPTER  XVIII 

How  Tuberculosis  is 

Spread  by  Contact  with 

the  Consumptive 

FOR  the  production  of  tuberculosis  there 
must  be  a  seed,  a  sowing,  a  growth,  a 
ripening,  and  a  harvest.  The  seed  is  the 
beginning  and  end  of  the  cycle  of  life  of 
the  bacillus. 

The  chief  source  of  seed  supply  is  the 
consumptive.  He  represents  the  end 
period  of  the  cycle  of  life, — the  harvest 
field  so  to  speak  of  tuberculosis. 

Tuberculosis  really  is  not  contagious 
until  the  tubercular  subject  becomes  a 
consumptive.  There  must  be  softening 
of  the  tubercles  and  emptying  out  of 
the  softened  matter  before  there  can  be 
contagion. 

Ii6 


Contact  with  the   Consumptive        117 

It  is  not  necessary,  however,  for  the  con- 
sumption to  be  advanced.  A  very  small 
nodule  may  soften  and  come  away — so 
small  as  to  give  no  symptoms. 

A  tubercular  subject  becomes  con- 
sumptive when  he  begins  to  spit  up 
tubercular  matter.  From  this  time  his 
disease  begins  to  be   contagious. 

The  contagiousness  of  tuberculosis  de- 
pends entirely  upon  the  broken-down  mat- 
ter. In  tuberculosis  of  the  lungs  it  is  the 
spit.  In  tuberculosis  of  other  parts  it  is  the 
matter  or  pus. 

There  is  no  contagion  in  the  breath 
of  a  consumptive.  During  the  acts  of 
coughing  and  sneezing,  however,  a  spray 
of  tubercular  matter  may  be  thrown  out 
of  the  mouth  and  nose. 

The  form  of  tuberculosis  which  most 
frequently  is  the  source  of  contagion  is 
tuberculosis  of  the  lungs.  In  this  form, 
after  softening  has  taken  place,  broken- 
down  matter  may  be  given  off  constantly 


ii8         Crusade  against   Tuber ctdosis 

in  small  quantities.  It  is  only  after  cavity 
formation,  however,  that  contagion  is  likely 
to  be  continuous. 

In  tuberculosis  of  other  internal  organs 
the  broken-down  matter,  if  given  off  at 
all,  comes  away  in  large  amounts,  usually 
at  one  time,  through  the  formation  of  an 
abscess.  Under  such  circumstances  there 
is  little  chance  of  contagion  because  the 
broken-down  matter  is  disposed  of  at  once. 

In  tuberculosis  of  the  skin  and  external 
lymphatic  glands  there  is  considerable  op- 
portunity for  contagion  on  account  of  the 
constancy  of  the  discharge.  The  danger 
is  much  less  than  with  tuberculosis  of  the 
lungs,  however,  as  the  amount  of  broken- 
down  tissue  is  less. 

A  consumptive  is  a  center  of  contagion. 
The  contagion  is  greatest  in  his  person  and 
diminishes  in  proportion  to  the  distance 
away  from  his  person. 

The  intensity  of  contagion  increases  in 
ratio  to  the  progress  of  the  disease  toward 


Contact  with  the  Consumptive         1 1 9 


a  fatal  issue.  The  deathbed  period  of 
consumption  probably  is  the  most  prolific 
time  of  new  implantations. 

The  contagion  does  not  extend  very  far 
away  from  the  person  of  the  consumptive. 
Even  in  the  room  in  which  he  lies  it  di- 
minishes in  ratio  to  the  distance  away  from 
the  head  of  his  bed. 

The  contagiousness  of  tuberculosis  de- 
pends much  upon  the  habits  of  the  con- 
sumptive. If  he  is  careful  about  where 
he  spits  and  is  cleanly  about  himself, 
keeping  his  hands  and  face  clean  and 
his  clothing  free  from  blemish,  he  practi- 
cally is  harmless.  In  proportion  as  he  is 
careless  and  uncleanly  he  becomes  dan- 
gerous. 

The  handkerchief  is  a  prolific  agent 
of  distribution  of  tubercular  matter.  The 
matter  which  is  deposited  in  the  handker- 
chief soils  the  hands,  the  lips,  and  the 
pocket  in  which  the  handkerchief  is  car- 
ried.    The  handkerchief  gives  off  moisture 


1 20  Crusade  against  Tuberculosis 

quickly  and  then  the  dried  tubercular  mat- 
ter is  scattered  broadcast  through  shaking 
of  the  handkerchief  when  in  use. 

The  use  of  rags  and  bits  of  lint  is 
equally  as  dangerous  as  the  use  of  hand- 
kerchiefs for  the  same  reasons.  People 
think  themselves  secure  in  the  use  of  such 
articles  because  they  afterward  bum  them 
instead  of  washing  them.  The  danger  is 
in  the  use,  however,  rather  than  in  the 
washing. 

The  hands  get  soiled  through  handling 
handkerchiefs  and  rags  and  such  things 
or  through  wiping  the  mouth  with  the 
hand  or  through  stroking  the  mustache 
and  whiskers.  By  handshaking  the  tuber- 
cular matter  then  is  distributed  to  others 
who  in  turn  carry  it  into  their  stomachs 
with  their  food. 

In  spitting  the  lips  get  soiled  and 
in  using  a  handkerchief  the  mouth  and 
face  get  smeared  with  matter.  Kissing 
upon  the  mouth  under  the  circumstances 


Contact  zuith  the   Consumptive        121 


or  even  upon  the  face  conveys  the  tuber- 
cular matter  to  the  Hps  of  the  person 
kissing. 

The  clothing  of  consumptives  who  are 
still  walking  about  frequently  becomes  con- 
taminated through  coughing  and  spitting, 
especially  when  they  try  to  spit  away 
from  themselves.  This  is  true  in  particu- 
lar with  men  who  wear  beards  and  mus- 
taches. 

Agitation  of  the  clothing  which  has  been 
contaminated  in  this  way  raises  a  fine  dust 
laden  with  tubercular  matter.  The  dis- 
tance around  about  a  consumptive  in  which 
this  dust  can  give  an  implantation  is  quite 
restricted,  however. 

The  bed-linen  and  bed-clothes  of  con- 
sumptives who  are  confined  to  bed  easily 
get  soiled  with  tubercular  matter.  This 
happens  partly  through  efforts  to  spit  into 
vessels  at  a  distance  and  partly  through 
placing  soiled  handkerchiefs  or  rags  under 
the  pillow. 


122  Crusade  against  Tuberculosis 

Contamination  of  bed-clothes  leads  to 
contamination  of  the  furniture  and  walls  of 
the  room.  The  tubercular  matter  on  the 
bed  clothes  dries  and  becomes  pulverized 
and  agitation  distributes  it  throughout  the 
room. 

Contaminated  bed  linens  and  handker- 
chiefs also  are  a  source  of  danger  to  the 
laundress.  Handling  of  the  linens  before 
washing  raises  a  fine  dust  which  contains 
tubercular  matter,  thus  placing  the  laun- 
dress in  a  contaminated  atmosphere.  She 
also  is  in  some  danger  of  contaminating 
her  hands,  and  through  her  hands  her 
food. 


CHAPTER  XIX 

Consumption  is   a 
House  Disease 

WELL  may  consumption  be  called  a  house 
disease.  Its  beginning  and  end  usually  are 
in  the  house.  The  seed  is  picked  up  in  the 
house  and  the  patient  finally  succumbs  to 
the  disease  in  the  house. 

The  tubercle  bacillus  in  every  sense  is  a 
house  plant.  It  finds  its  most  favorable 
conditions  for  preservation,  implantation, 
growth,  and  association  with  other  micro- 
organisms in  the  house. 

Vital  tubercular  matter  accumulates  in  a 
house  because  it  is  not  easily  devitalized. 
As  time  goes  on  the  number  of  living 
bacilli  in  the  house  increases  to  such  a 
degree  as  to  make  it  possible  for  a  large 
enough  number  to  get  into  the  system  at 
one  time  to  overcome  resisting  power. 

123 


124         Criisade  against  Tuberculosis 

Houses  which  are  occupied  by  consump- 
tives not  only  are  breeding-grounds  for 
consumption  during  the  Hfetime  of  the  per- 
son afflicted,  but  for  a  long  time  after  his 
death.  As  a  rule  they  have  a  long  list 
of  deaths  to  their  credit. 

Houses  of  this  kind  have  been  tabulated 
for  statistical  purposes.  It  has  been  shown 
that  they  have  deaths  from  consumption 
every  year  or  two. 

A  happy  family  moves  into  such  a  house 
in  good  health,  unconscious  of  what  is  in 
store  for  them.  By  and  by  a  member  who 
occupies  a  certain  room,  perhaps  the  best, 
begins  to  fail  in  health.  Inquiry  discloses 
that  a  former  occupant  of  that  room  had 
died  of  consumption. 

When  the  deaths  from  consumption  in  a 
given  district  are  tabulated  for  a  period  of 
twenty-five  years,  it  is  found  that  they  have 
occurred  in  only  about  one-fourth  of  the 
houses  of  the  district.  Side  by  side  with 
the    contaminated    houses    stand    houses 


Consumption  is  a  House  Disease     125 

which  have  remained  free  from  the  dis- 
ease. 

This  predilection  of  the  disease  for  cer- 
tain houses  even  holds  good  in  the  slum 
districts.  On  the  worst  streets  only  two- 
thirds  of  the  houses  are  visited  by  the  dis- 
ease during  that  time. 

This  recurrence  of  the  disease  in  certain 
houses  and  non-occurrence  in  others,  stand- 
ing side  by  side  with  them,  shows  how 
much  the  tubercle  bacillus  depends  upon 
the  house  for  implantation.  It  shows  how 
much  consumption  is  a  house  disease. 

The  house  is  well  constituted  as  a  breed- 
ing-ground for  consumption.  Tubercular 
matter  which  gets  upon  the  walls,  furniture, 
carpet,  and  hangings,  in  the  form  of  dust, 
retains  its  viability  for  a  long  time  on  account 
of  the  absence  of  sunlight  and  the  stagna- 
tion of  the  air. 

Houses  as  built  and  furnished  give  the 
very  best  conditions  for  implantation  and 
growth  of  the   tubercle   bacillus.     In  this 


126         Crusade  against  Tuberculosis 

regard  civilization  has  been  a  conspiracy 
against  human  happiness. 

Civilization  has  been  blamed  for  bringing 
consumption  into  the  world.  In  a  way 
the  blame  is  Avell  laid.  Civilization  has 
brought  us  houses,  and  houses  have  much 
to  do  with  the  spread  of  tuberculosis. 

In  pursuit  of  happiness  man  needed  pri- 
vacy and  protection.  He  accordingly  built 
his  castle  to  shut  himself  in  and  to  shut 
his  enemies  out.  With  his  enemies  he  has 
shut  out  his  friends,  the  sun  and  fresh  air. 

Man  needs  sunlight  and  fresh  air  for 
prosperity.  The  tubercle  bacillus  needs 
darkness  and  stagnant  air.  Houses  are 
built  and  furnished  to  shut  out  the  sun  and 
air  as  much  as  possible. 

In  cities,  moreover,  houses  are  built  too 
close  together  for  the  sun  and  air  to  get  at 
them  and  through  them.  Streets  are  nar- 
row, and  where  the  poor  live  often  have 
but  one  outlet. 

Streets  with  one  outlet  have  a   higher 


Consumption  is  a  House  Disease     127 

death-rate  from  consumption  than  have 
streets  which  are  cut  through.  Houses 
which  stand  back  to  back  have  a  higher 
death-rate  than  have  houses  which  run 
from  street  to  street. 

Houses  which  are  built  on  damp,  non- 
porous  soil  have  a  higher  death-rate  than 
have  houses  which  are  built  on  a  dry,  well- 
drained  soil.  These  facts  at  one  time  led 
to  the  belief  that  dampness  was  a  cause  of 
consumption. 

Houses  not  only  favor  the  bacillus  by 
preserving  its  life  and  helping  it  to  get  into 
a  new  host,  but  prepare  its  victim  by  reduc- 
ing his  vitality.  Fresh  air  and  sunlight 
are  requisite  for  healthy  nutrition. 

The  development  of  tuberculosis  into 
consumption  and  the  progress  of  consump- 
tion to  a  fatal  issue  are  facilitated  by  indoor 
life.  With  ample  sunlight  and  fresh  air 
the  human  organism  would  have  a  better 
chance  to  successfully  struggle  against  the 
tubercle  bacillus  and  its  associates. 


CHAPTER  XX 

The  Workshop  in  the 

Spread  of  Tuber- 
culosis 

THE  dwelling-place  of  the  consumptive 
is  the  richest  granary  of  the  tubercle  bacil- 
lus known.  It  is  made  so  because  the  con- 
sumptive spends  most  of  his  time  in  it 
during  the  contagious  period  of  the  disease. 
The  last  few  months  of  life  are  almost 
entirely  spent  in  the  dwelling. 

On  account  of  the  long  duration  ot  con- 
sumption, however,  other  places  than  the 
dwelling  likewise  become  rich  granaries  of 
the  bacillus.  The  foremost  among  these  is 
the  workshop  or  factory. 

It  would  be  difficult  to  estimate  the  aver- 
age length  of  time  which  the  consumptive 
devotes  to  his  business  before  giving  up. 

128 


The  Workshop  and  Tuberadosis    129 

It  is  undoubtedly  much  longer  than  gener- 
ally is  supposed.  With  some  it  is  nearly  a 
lifetime. 

It  is  true  consumption  is  not  contagious 
during  the  entire  working  period.  Often 
there  are  intervals  of  months  and  even 
years  during  which  no  broken-down  tissue 
is  given  off. 

In  every  case,  however,  there  are  months 
at  a  time,  following  a  cold  or  an  attack  of 
softening,  during  which  the  patient  works 
and  gives  off  contagion.  After  cavity 
formation  contagion  usually  is  continuous. 

The  workshop  does  not  gather  up  tuber- 
cular matter  as  rapidly  as  the  dwelling, 
because  the  consumptive  spends  less  time  in 
it,  and  whilst  in  it  is  less  productive  of 
tubercular  matter.  In  the  end,  however, 
it  becomes  as  much  contaminated  on  ac- 
count of  uncleanliness. 

There  is  less  restraint  in  the  workshop 
than  in  the  home.  As  a  rule,  the  workman 
spits  where  convenient  in  his  place  of  em- 


130         Crusade  against  Tuberculosis 

ployment.  The  dirtier  the  place,  the  more 
careless  he  is  about  where  he  spits. 

The  dirt  and  tubercular  matter  dry  out 
and  are  ground  up  into  fine  dust.  This  is 
always  suspended  in  the  atmosphere  while 
there  is  activity  in  the  shop,  and  is  depos- 
ited upon  everything  in  the  shop  when 
work  is  interrupted. 

Fellow-workmen  inhale  the  tubercle- 
laden  dust  with  every  breath  and  carry  it 
into  their  stomachs  with  their  food  while 
eating  their  luncheons. 

The  conditions  for  implantation  of  the 
tubercle  bacillus  are  nearly  as  good  in  the 
workshop  as  they  are  in  the  home.  The 
only  difference  is  that  the  exposure  to  con- 
tagion is  not  quite  as  continuous  nor  is  the 
contagion  quite  as  intense. 

In  the  workshop  exposure  usually  is  for 
eight  hours  only  out  of  the  twenty-four ;  in 
the  home  it  is  for  sixteen  and  sometimes 
for  the  entire  twenty-four.  The  time  dur- 
ing which  the  greatest  amount  of  expec- 


The  Workshop  and  Tuberculosis    131 

toration  takes  place,  moreover,  is  the  morn- 
ing and  the  evening,  and  this  usually  is 
spent  in  the  home. 

Implantation  of  the  tubercle  bacillus  in 
the  workshop  is  facilitated  very  much  by 
bad  ventilation.  Workshops  are  built  for 
the  business  and  not  for  the  employees. 
The  health  of  the  employees  rarely  is 
thought  of  in  the  construction. 

The  amount  of  cubic  air-space  to  the 
individual  requisite  for  health  while  indoors 
is  not  considered  and  no  provision  is  made 
for  efficient  ventilation.  Erroneous  ideas 
about  taking  cold  from  open  windows 
makes  the  employee  shut  off  the  only 
source  of  ventilation  at  his  command. 

In  some  kinds  of  business,  moreover, 
open  windows  are  not  permitted  because 
they  would  interfere  with  good  work.  This 
applies  especially  to  some  kinds  of  paint- 
ing, to  varnishing,  and  to  cigar-making. 

Rebreathed  air  is  poisonous  and  inter- 
feres with  nutrition.     It   therefore    makes 


132         Crusade  against  Tuberculosis 

good  soil  for  the  tubercle  bacillus  and  its 
associates.  It  moreover  works  along  the 
same  line  of  destruction. 

Workshops  into  which  tuberculosis  once 
has  been  introduced  have  their  victims  con- 
tinuously at  regular  intervals.  As  one  case 
ends,  another  begins.  Usually  they  get  a 
long  list  of  deaths  marked  up  against  them. 

Workshops  in  which  the  occupation  sets 
up  a  very  irritating  dust,  such  as  steel  fil- 
ings or  pulverized  stone,  usually  have  a 
very  high  death-rate  from  consumption. 
The  irritation  set  up  in  the  delicate  mucous 
membrane  prepares  the  way  for  the  admis- 
sion of  the  tubercle  bacillus  into  the  bron- 
chial lymphatic  glands. 


CHAPTER  XXI 

The  Store  in  the  Spread 
of  Tuberculosis 

WHEREVER  a  consumptive  is  during  the 
contagious  period  of  his  disease  there  is  an 
environment  of  contagion.  The  capacity 
of  this  environment  for  implantation,  how- 
ever, depends  upon  the  habits  of  the  con- 
sumptive, the  length  of  time  of  contact, 
and  the  sanitary  management  of  the  place. 

If  the  habits  of  the  consumptive  are  in 
strict  accord  with  the  teachings  of  pre- 
ventive medicine,  the  environment  remains 
sterile,  no  difference  what  the  length  of  time 
of  contact  or  the  sanitary  management  of 
the  place  may  be.  In  proportion  as  these 
habits  deviate  from  the  teachings  of  science, 
length  of  time  of  contact  and  sanitary 
management  become  controUing  factors. 

How  much  time  a  consumptive  with  in- 

133 


134        Crusade  against  Tuber ciilosis 

correct  habits  must  spend  in  a  place  to 
create  an  environment  competent  to  im- 
plant the  tubercle  bacillus  cannot  be  deter- 
mined with  exactness.  Other  factors,  such 
as  the  amount  of  tubercular  matter  given 
off,  the  susceptibility  of  those  exposed,  and 
the  sanitary  condition  of  the  environment, 
enter  into  the  matter. 

It  may  be  said,  however,  with  a  fair  de- 
gree of  positiveness  that  it  must  be  a  con- 
siderable time.  Momentary  stay  in  a  place, 
no  difference  what  the  habits  or  the  sani- 
tary condition,  will  not  produce  such  an 
environment 

Neither  can  it  be  determined  with  accu- 
racy what  part  the  sanitary  condition  plays 
in  the  establishment  of  a  fertile  environ- 
ment. In  a  general  way  it  may  be  said, 
however,  that  good  sanitation  proportion- 
ately neutralizes  incorrect  habits  and  length- 
ens the  time  of  contact  necessary  for  im- 
plantation. 

These    modifying  factors  of  contagious 


The  Store  and  Tuberculosis  135 


environment  must  be  kept  in  mind  when 
studying  stores  in  the  spread  of  consump- 
tion. In  stores  we  not  only  have  the  fel- 
low-employee to  consider,  but  also  the 
purchaser. 

In  nearly  all  large  stores  there  are  con- 
sumptives in  all  stages  of  the  disease,  from 
a  mere  implantation  to  the  large  cavity 
at  which  the  disease  constantly  is  conta- 
gious. Probably  twenty-five  per  cent,  of 
all  store  employees  have  an  implantation 
of  tuberculosis. 

Stores  prepare  people  for  invasion  of  the 
tubercle  bacillus.  Ventilation  is  bad  and 
the  air  constantly  is  rebreathed.  The  em- 
ployees, as  a  rule,  are  badly  nourished  and 
are  in  a  receptive  condition. 

Stores,  however,  fortunately  are  not  very 
good  granaries  for  the  tubercle  bacillus. 
They  are  large  and  have  to  be  kept  clean. 
The  constant  presence  of  many  people  to 
some  extent  enforces  habits  of  cleanliness 
and  refined  manners. 


136  Crusade  against  Tuberculosis 

The  spread  of  tuberculosis  in  stores 
chiefly  is  from  employee  to  employee.  The 
persons  most  exposed  are  those  who  work 
side  by  side  with  the  consumptive. 

Fertile  environment  probably  does  not 
extend  beyond  the  counter  of  the  con- 
sumptive. Even  this  lessens  in  proportion 
to  the  distance  away  from  the  place  where 
the  consumptive  stands. 

Purchasers  probably  do  not  run  any  risk 
while  making  the  purchase.  However  in- 
tense the  contagion,  exposure  is  too  short 
to  give  an  implantation.  Tuberculosis  re- 
quires a  long  intimate  exposure  for  im- 
plantation. 

The  real  danger  to  the  purchaser  lies  in 
the  things  which  he  carries  home  with  him 
or  which  are  sent  into  his  house.  An  un- 
clean consumptive  contaminates  everything 
which  he  handles.  Goods  handled  by  such 
a  consumptive  may  be  smeared  with  a  good 
deal  of  tubercular  matter. 

Even  from  the  things  sent  home,  how- 


The  Store  and  Tuber adosis  137 

ever,  the  danger  is  not  great,  unless  per- 
haps with  food  which  is  eaten  in  the  raw 
state.  Other  things  would  not  be  apt  to 
convey  enough  bacilli  to  give  an  implanta- 
tion except  to  people  of  a  very  strong  pre- 
disposition. 

The  kind  of  stores  from  which  there  is 
most  danger  to  the  purchaser  are  candy- 
stores,  fruit-stores,  and  grocery-stores. 
Even  from  these,  however,  there  is  prac- 
tically no  danger  unless  purchases  are  made 
daily  for  a  considerable  period  of  time. 

The  number  of  tubercle  bacilli  which  one 
can  get  ordinarily  from  once  eating  contam- 
inated candy,  fruit,  or  raw  food  of  any  kind 
will  not  give  an  implantation  unless  there 
is  extraordinarily  good  soil.  The  disease- 
fighting  power  of  the  body  has  to  be  over- 
come before  an  implantation  can  take  place. 


CHAPTER  XXII 

The  Office  in  the  Spread 
of  Tuberculosis 

THE  sedentary  life  of  the  clerk  always  has 
been  looked  upon  as  a  prolific  cause  of 
consumption.  Out  of  this  association  of 
ideas  grew  the  popular  belief  that  inactivity 
has  much  to  do  with  the  production  of 
consumption. 

Like  the  popular  idea  about  the  causal 
relation  between  cold  and  consumption,  this 
notion  about  inactivity  often  has  been  an 
impediment  to  recovery.  Looking  back 
from  effect  to  cause  for  a  remedy,  people 
have  sought  health  but  found  death  in 
overactivity. 

Popular  reasoning  was  something  like 
this :  An  inactive  life  means  disuse  of  the 
lungs,  disuse  of  the  lungs  leads  to  decay, 
and  decay  is  consumption.     Bending  over 

138 


The   Office  and  Tuberculosis  139 

the  desk,  with  what  was  believed  to  be 
consequent  round  shoulders,  likewise  was 
given  some  blame. 

Contagion,  the  real  cause,  never  was  sus- 
pected. We  now  know,  however,  that  the 
reason  why  clerks  frequently  are  victims  of 
consumption  is  because  the  offices  which 
they  occupy  are  environments  of  contagion. 

Offices  are  peculiarly  well  adapted  for 
contagious  environment  of  tuberculosis. 
They  rarely  have  enough  cubic  air-space 
for  the  number  of  people  employed  in 
them. 

As  a  rule,  clerks  object  to  having  win- 
dows open.  Inactivity  slows  down  their  cir- 
culation and  makes  them  sensitive  to  cold. 
Cross-ventilation,  moreover,  may  disturb 
papers  and  books. 

The  consumptive  clerk  above  all  objects 
to  having  the  windows  open.  He  thinks 
he  caught  his  cough  from  an  open  window, 
and  he  anxiously  guards  himself  against 
fresh  colds. 


140  Crusade  against  Tuberculosis 

Offices  usually  are  furnished  with  spit- 
toons at  short  distances  one  from  another. 
It  is  customary  for  the  clerks  to  spit  into 
the  spittoons  from  where  they  stand  or  sit. 
Frequently  the  spitter  misses  his  aim  and 
hits  the  outside  of  the  spittoon  or  spits  on 
the  floor. 

A  consumptive  who  spits  into  a  spittoon 
creates  a  contagious  environment  in  two 
ways.  He  sprays  tubercular  matter  over 
his  clothing  and  into  the  air  around  him 
and  puts  tubercular  matter  where  it  will  dry 
and  be  scattered  about  A  considerable 
area  about  the  spittoon  becomes  covered 
with  dried  tubercular  matter. 

Every  time  such  a  consumptive  agitates 
his  clothing  he  throws  into  the  atmosphere 
tubercle-laden  dust.  In  the  evening  the 
broom  of  the  office-cleaner  stirs  up  the 
dried  matter  on  the  floor  and  sets  it  afloat. 

Overnight  the  tubercle-laden  dust  settles 
on  the  walls,  the  furniture,  and  the  books. 
Hustle  and  bustle  in  the  office  on  the  fol- 


The   Office  and  Tuberculosis  141 

lowing  day  again  sets  it  afloat,  and  reinforce- 
ment of  tubercular  matter  comes  from  the 
same  source  as  came  the  matter  on  the  day 
before.  In  time  a  contagious  environment 
is  thus  created  capable  of  giving  implanta- 
tions. 

In  the  office  as  in  the  workshop  and  store 
the  greatest  danger  is  to  the  clerk  who  is 
next  to  the  consumptive.  The  contagious 
environment  is  circumscribed  and  does  not 
extend  far  from  the  person  who  creates  it. 

Persons  somewhat  removed  from  the 
consumptive,  unless  very  much  predisposed 
to  the  disease,  are  not  apt  to  take  in  a  large 
enough  number  of  bacilli  at  one  time  to 
produce  an  implantation.  Even  in  inocula- 
tion experiments  there  is  a  minimal  dose 
for  fertility. 

An  office  which  has  acquired  a  fertile 
environment  of  contagion  can  give  an  im- 
plantation to  occupants  even  after  the  con- 
taminating person  has  left  it.  The  place 
occupied  by  the  consumptive  and  the  furni- 


142         Crusade  against  Tiiberculosis 

ture  and  books  used  by  him  are  the  greatest 
source  of  danger. 

Offices  which  once  have  become  con- 
taminated usually  have  a  number  of  vic- 
tims to  their  credit  before  they  again  become 
sterile.  Such  offices  may  have  from  three 
to  five  consecutive  deaths  in  close  succes- 
sion. 

Large  offices  in  which  many  clerks  are 
employed  usually  at  all  times  have  tubercu- 
lar subjects  in  all  stages  of  the  disease. 
Some  are  just  beginning,  some  are  near 
their  end,  and  some  maintain  an  even  con- 
dition of  health  in  spite  of  the  tubercular 
process  for  a  lifetime. 


CHAPTER   XXIII 

Hotels    and    Boarding- 
houses  in  the  Spread 
of  Tuberculosis 

CONSUMPTION  is  a  house  disease.  It 
is  contagious.  The  knowledge  of  these 
facts  causes  uneasiness  to  people  who  live 
under  roofs  which  they  do  not  control  and 
who  have  to  change  their  places  of  abode 
at  frequent  intervals. 

Fear  of  contagion  on  the  part  of  guests 
has  driven  hotel-keepers  and  boarding- 
house  keepers  to  close  their  doors  to  con- 
sumptives. This  is  a  great  hardship  on 
people  who  already  are  much  afflicted,  and 
is  unwarranted.  Proper  regulation  of  the 
conduct  and  habits  of  consumptive  guests 
would  give  ample  protection. 

People  who  live  in  hotels  and  boarding- 
houses  run  less  risk  of  contracting  tuber- 

143 


144        Crtisade  against  Tuberculosis 

culosis  from  fellow-guests  or  guests  who 
have  preceded  them  than  they  imagine. 
Implantation  of  tuberculosis  is  not  at  all 
easy. 

It  takes  some  time  to  produce  an  en- 
vironment fertile  enough  to  implant  the 
tubercle  bacillus.  It  also  takes  some  time 
to  get  an  implantation  from  such  an  en- 
vironment when  it  is  fertile. 

There  is  really  no  danger  of  taking 
tuberculosis  from  a  fellow-guest  in  a  hotel 
unless  there  is  a  very  intimate  relationship. 
The  contact  which  ordinarily  exists  between 
guests  in  hotels  is  not  close  and  prolonged 
enough  to  produce  an  implantation. 

The  danger  of  taking  tuberculosis  from 
a  preceding  guest  in  a  hotel  ordinarily  is 
not  very  great  either.  Hotel  life  usually  is 
too  transient  both  for  producing  a  fertile 
environment  and  for  taking  an  implantation. 

The  consumptive  who  occupies  a  room 
in  a  hotel  seldom  stays  long  enough  to 
produce  a  contagious   environment.     The 


Hotels  and  Tuberculosis  145 

healthy  person  who  follows  him  does  not 
remain  long  enough  to  get  an  implantation. 

An  exception  to  this  rule  probably  is  to 
be  found  in  health-resorts,  where  hotels  are 
frequented  for  the  purpose  of  regaining 
health.  Consumptives  remain  long  enough 
in  such  hotels  to  produce  a  contagious  en- 
vironment and  other  guests  remain  long 
enough  to  get  an  implantation. 

In  such  hotels,  too,  subsequent  occu- 
pants frequently  are  predisposed  to  tuber- 
culosis by  reason  of  bad  health  from  some 
other  cause.  They  may  have  been  at- 
tracted to  the  place  by  its  reputation  as  a 
health-resort. 

People  frequently  go  to  health-resorts 
while  convalescent  from  some  acute  dis- 
ease. Many  of  the  acute  diseases  are 
looked  upon  as  predisposing  causes  of  con- 
sumption. 

Tuberculosis  no  doubt  occasionally  gets 

into  a  family  by  way  of  the   hotel  among 

wealthy  people.     All  in  all,  however,  the 
10 


146  Crusade  against  Tuberculosis 

hotel    probably  seldom    is    the    means    of 
spreading  the  disease. 

Boarding-house  life  is  more  fraught  with 
danger  of  getting  tuberculosis  than  is  hotel 
hfe.  The  conditions  for  producing  environ- 
ment and  for  implantation  both  are  better. 

The  population  of  boarding-houses  is 
more  permanent  than  that  of  hotels.  In 
proportion  as  occupancy  is  longer,  the 
chances  of  producing  contagious  environ- 
ment and  getting  implantations  are  better. 

In  a  boarding-house  a  consumptive  is 
almost  certain  to  occupy  his  room  long 
enough  to  produce  a  contagious  environ- 
ment. Likewise  a  subsequent  occupant  is 
apt  to  stay  long  enough  to  get  the  disease. 

There  also  is  some  danger  in  a  boarding- 
house  of  getting  tuberculosis  from  a  fellow- 
boarder.  The  boarding-house  is  something 
like  the  home.  The  inmates  are  all  as  of 
one  family.  Contact  is  more  or  less  inti- 
mate between  all. 

Life  in  a  boarding-house,  moreover,  to 


Hotels  and  Tuberculosis  147 

some  extent  predisposes  to  tuberculosis. 
Cooking  often  is  bad  and  food  is  of  an  in- 
ferior quality. 

To  some  extent,  too,  people  who  live  in 
boarding-houses  are  predisposed  to  tuber- 
culosis by  occupation.  Frequently  they 
are  overworked. 

In  neither  boarding-houses  nor  hotels, 
however,  is  there  enough  danger  of  con- 
tracting tuberculosis  to  warrant  exclusion 
of  those  who  are  suffering  from  the  disease. 
Better  protection  can  be  given  by  kindness 
than  by  cruelty. 


CHAPTER  XXIV 

The  Spread  of  Tubercu- 
losis by  Consumptive 
Servants 

CONSUMPTION  largely  is  a  disease  of 
the  poor.  The  conditions  of  life  and  the  en- 
vironments of  the  poor  strongly  predispose 
to  it  and  present  excellent  opportunities  for 
the  spread  of  contagion. 

Well-to-do  people  are  not  exempt  from 
the  disease,  however,  although,  considering 
all  things,  one  might  well  expect  them  to 
be.  They  live  under  conditions  and  environ- 
ments which  ought  to  shield  them  against 
contagion  and  prevent  them  from  develop- 
ing the  disease  after  getting  an  implanta- 
tion. 

Their  houses  are  well  situated,  large,  well 
ventilated,  and  clean.  They  have  all  the 
necessaries  of  life  and  even  luxuries.    They 

148 


Domestics  and  Tuberculosis  149 

are  exempt  from  the  many  predisposing 
causes  which  grow  out  of  poverty. 

Their  only  predispositions  are  those  which 
are  natural  and  those  which  grow  out  of 
dissipation.  Excessive  eating  and  drinking 
and  loss  of  sleep  probably  constitute  their 
chief  acquired  predisposing  causes. 

Their  mode  of  life  exempts  them  from 
contagion  in  many  respects,  but  not  in  all. 
At  some  points  they  are  much  exposed. 
Such  points  of  exposure  often  are  over- 
looked. 

All  society  hangs  together.  At  the  point 
of  cleavage  the  rich  are  exposed  to  the 
same  contagions  as  the  poor. 

Domestics  of  all  kinds  are  prone  to  tuber- 
culosis. When  they  have  the  disease,  they 
usually  hold  on  to  their  positions  until  it  is 
far  advanced.  They  can  do  so  because 
their  work  is  relatively  easy. 

Domestics,  from  the  very  nature  of  things, 
constitute  part  of  the  household  of  their 
employers.     They  enter  into  the  most  inti- 


150  Crusade  against  Tuberculosis 

mate  relationship  with  members  of  the 
family.  For  the  purposes  of  contagion 
they  are  part  of  the  family. 

Children  of  wealthy  parents  often  are  in 
closer  contact  with  domestics  than  they  are 
with  their  own  parents.  They  eat  and 
sleep  in  the  same  room  with  them  and  often 
are  fed  and  caressed  by  them. 

A  nurse-girl  with  consumption  creates 
an  amply  fertile  environment  of  contagion 
for  the  children  under  her  care.  The  chil- 
dren can  hardly  escape  getting  an  implan- 
tation. 

Implantations  which  take  place  under 
such  circumstances  may  not  grow  into  con- 
sumption until  later  in  life.  Sometimes 
they  do  not  develop  enough  to  show  them- 
selves until  old  age. 

The  consumptive  chambermaid  has  every 
opportunity  of  contaminating  the  bed-rooms 
of  the  family  in  which  she  is  employed. 
Contamination  of  this  kind  is  not  apt  to  be 
very  intense,  however.     It  probably  would 


Domestics  and  Tttberculosis  151 

not  give  implantations  except  to  those  who 
are  much  predisposed. 

The  consumptive  cook,  waiter,  and  but- 
ler are  liable  to  contaminate  the  food  which 
they  prepare  and  serve  to  the  families  of 
their  employers.  They  may  do  this  in 
handling  the  food  and  also  by  producing 
a  contagious  environment  in  the  kitchen, 
dining-room,  and  pantry. 

Consumptive  domestics,  as  a  rule,  have 
no  homes  other  than  those  of  their  em- 
ployers. Quite  naturally  they  make  every 
effort  to  keep  these  homes  when  they  are  ill. 

In  order  to  escape  prejudice,  they  keep 
the  nature  of  their  ailments  from  their  em- 
ployers as  long  as  possible.  In  this  effort 
at  concealment  lies  the  greatest  danger. 

Preventive  measures  against  tuberculosis 
cannot  be  practised  without  attracting  at- 
tention. Broken-down  tissue,  therefore,  is 
deposited  in  handkerchiefs  and  in  out-of- 
the-way  places,  because  this  can  be  done  in 
concealment. 


152  Crusade  against  Tuberculosis 

In  the  hands  of  the  domestic  the  hand- 
kerchief is  perhaps  even  a  greater  source 
of  danger  than  it  is  in  the  hands  of  other 
people.  Domestics  constantly  handle 
things  of  every  kind  and  description,  and 
with  soiled  hands  they  contaminate  every- 
thing they  handle. 


CHAPTER  XXV 

The   School-room  in    the 
Spread  of  Tuberculosis 

CHILDREN  of  school  age  have  a  very- 
low  death-rate  from  consumption.  Sta- 
tistics show  that  the  lowest  death-rate 
from  the  disease  is  in  the  age-period  be- 
tween five  and  fifteen  years. 

This,  however,  does  not  mean  necessa- 
rily that  children  of  this  age-period  do  not 
get  implantations.  The  implantation  may 
take  place  and  the  full-fledged  disease 
may  not  follow  until  adult  life. 

Statistics,  moreover,  may  not  tell  the 
whole  truth  about  the  death-rate  from 
consumption  in  childhood.  Tuberculosis 
oftener  travels  in  disguise  during  child- 
hood than  during  adult  life. 

Many  of  the  deaths  in  childhood  which 

153 


154         Crusade  against  Tuberculosis 

are  recorded  under  the  names  of  convul- 
sions, inanition,  diarrhea,  inflammation  of 
the  brain,  and  inflammation  of  the  bowels 
really  are  caused  by  tuberculosis. 

There  are  many  forms  of  tuberculosis  in 
childhood,  too,  which  do  not  appear  in  the 
statistics  of  deaths  from  consumption. 
Among  these  are  tuberculosis  of  the  bones 
and  lymphatic  glands.  Usually  they  end 
in  consumption  in  adult  life. 

Teachers  are  quite  prone  to  consump- 
tion. They  are  predisposed  by  overwork 
and  malnutrition.  Their  work  is  hard  and 
they  are  underpaid. 

Whatever  contagion  of  tuberculosis 
there  may  be  in  the  school-room  probably 
comes  mainly  from  the  teachers.  Even 
when  children  have  tuberculosis  they  are 
not  apt  to  have  it  in  a  contagious  form. 

Teachers  as  a  rule  are  clean  and  refined. 
These  very  qualities,  however,  lead  them 
into  dangerous  habits.  For  ethical  reasons 
they    spit   into    handkerchiefs.       Through 


School-rooms  and  Tuberculosis       155 

handkerchiefs  they  contaminate  everything 
about  them. 

A  consumptive  teacher  may  spread  con- 
tagion by  creating  a  fertile  environment  in 
the  school-room  and  by  contaminating 
those  things  which  pass  between  him  and 
the  children.  The  fertility  of  the  environ- 
ment and  contamination  depend  upon  the 
habits  of  the  teacher. 

Ordinarily  environment  created  by  a  con- 
sumptive teacher  is  not  likely  to  be  fertile 
enough  to  give  rise  to  implantations  among 
the  pupils.  School-rooms,  as  a  rule,  are 
too  large  to  become  fertile  in  every  part 
and  pupils  are  not  very  close  to  the  teacher. 

There  is  more  danger,  however,  of  chil- 
dren getting  implantations  from  things 
which  have  been  handled  by  the  teacher. 
The  hands  of  the  children  get  smeared  in 
this  way  and  the  tubercular  matter  may 
find  its  way  into  their  stomachs  with  their 
food  when  they  take  their  luncheons. 

Consumptive  teachers  may  give  the  dis- 


156  Crusade  against  Tuberculosis 

ease  to  other  teachers.  The  contact  be- 
tween teacher  and  teacher  is  closer  than 
that  between  teacher  and  pupil. 

Consumptive  pupils,  when  they  do  exist 
in  a  school-room,  are  a  greater  source  of 
danger  to  other  pupils  than  are  consump- 
tive teachers.  This  is  because  they  are  in 
more  intimate  contact  with  them. 

School-rooms  really  are  not  a  prolific 
source  of  spreading  tuberculosis.  Pupils 
do  not  have  the  disease  often  in  contagious 
form,  and  teachers,  when  they  do  have  it, 
are  not  very  apt  to  give  rise  to  an  environ- 
ment or  contamination  capable  of  giving 
the  disease  to  others. 

Schools  may  indeed  be  a  protection  to 
children  against  tuberculosis  under  cei-tain 
conditions.  Among  the  very  poor,  when 
there  is  tuberculosis  in  the  child's  home, 
the  child  is  much  safer  at  school  than  at 
home. 

The  hours  which  the  child  spends  in 
school  each  day  may  give  sufficient  truce 


School-rooms  and  Tuberculosis       157 

in  the  battle  against  the  tubercle  bacillus 
to  enable  the  child's  organism  to  win  out 
in  the  struggle  against  implantation.  They 
break  the  continuous  exposure  which  the 
child  otherwise  would  have  to  undergo  in 
its  home. 


CHAPTER   XXVI 

Churches  and  Public 

Halls  in  the  Spread  of 

Tuberculosis 

CONTACT  is  the  dominating  factor  in 
the  spread  of  tuberculosis.  Without  it 
the  disease  cannot  be  propagated. 

Mere  contact,  however,  is  insufficient. 
There  must  be  a  certain  amount  of  it. 
Quantity  as  measured  by  time,  therefore, 
likewise  is  an  essential  factor. 

How  long  contact  must  endure  to  give 
implantation  cannot  be  determined  even 
approximately.  Too  many  other  factors 
enter  into  the  calculation,  such  as  im- 
munity, predisposition,  sanitation,  and  fer- 
tility of  contagious  environment. 

It  unhesitatingly  may  be  said,  however, 
that   contact    under    certain    circumstances 

IS8 


Churches  and  Tuberculosis  159 

and  conditions  is  too  short  to  permit  of 
implantation.  This  statement,  moreover, 
appHes  to  both  direct  and  indirect  contact. 

Contact,  for  instance,  of  half  an  hour, 
or  perhaps  even  of  two  and  three  hours, 
probably  would  not  give  rise  to  implan- 
tation under  any  circumstances  ;  and  con- 
tact of  a  day,  of  two  or  three  days,  and 
perhaps  even  of  a  week  or  two,  under 
certain  conditions  and  circumstances  might 
not  be  followed  by  implantation. 

In  churches  and  public  halls  contact 
with  consumptives  always  is  brief  People 
do  not  remain  in  such  places  long  and 
they  visit  them  only  at  intervals. 

Exposure  to  a  consumptive  in  a  church 
or  pubHc  hall  for  an  hour  or  two  could 
not  give  rise  to  an  implantation  even  in 
the  most  susceptible  person.  The  ele- 
ment of  time  would  be  wanting. 

Even  if  the  consumptive  were  ever  so 
unclean  and  unmannerly  and  the  sanitary 
condition  of  the  church  or  hall  were  ever 


i6o         Crusade  against  Tuberculosis 

so  bad,  the  shortness  of  time  would  not 
permit  of  an  implantation.  It  would  be 
like  an  underexposure  in  photography — 
it  would  not  develop. 

Consumptives  who  spit  into  handker- 
chiefs may  contaminate  the  pew  or  chair 
in  which  they  sit  in  church  or  hall.  Their 
clothing  contains  tubercle-laden  dust  and 
their  hands  are  smeared  with  tubercular 
matter.  They  are  bound  to  contaminate 
every  place  which  they  occupy. 

The  contamination  which  they  can  give 
a  pew  or  chair  in  an  hour  or  two,  once 
or  twice  a  week,  is  too  attenuated,  however, 
to  set  up  a  fertile  contagious  environment. 
The  environment  which  is  created  prob- 
ably could  not  convey  tuberculosis  even 
to  the  most  susceptible. 

Consumptives  who  spit  on  the  floor  of 
a  church  or  hall  create  a  more  dangerous 
environment  than  do  those  who  spit  into 
handkerchiefs.  The  sputum  dries  on  the 
floor,    disintegrates,  and   becomes   pulver- 


Halls  and  Tuberculosis  i6i 

ized,  and  then  is  distributed  by  the  broom 
of  the  janitor  or  cleaner. 

The  amount  of  sputum  which  can  be 
ejected  upon  the  floor  of  a  church  or 
hall  by  an  occasional  consumptive  attend- 
ant is  not  sufficient,  however,  to  produce 
a  fertile  environment  of  contagion  for  the 
whole  church  or  hall.  The  danger  does 
not  extend  far  beyond  the  place  where  the 
consumptive  sits. 

Even  the  exact  spot  in  which  he  sits 
probably  would  not  be  fertile  enough 
to  give  an  implantation  to  persons  sitting 
in  it  subsequently.  The  contagion  neces- 
sarily would  be  weak  and  the  length  of 
time  of  occupation  by  subsequent  visitors 
would  be  short. 

The  only  persons  who  really  are  likely 

to    get   tuberculosis   in  a   church    or    hall 

are    janitors     and    cleaners.        Tubercular 

matter  which    has  been  deposited    on   the 

floor  is    stirred    up  by  them  and   inhaled 

while  cleaning. 
11 


1 62         Crusade  against  Tuberculosis 

They  are  exposed  to  the  contagion 
every  time  they  sweep  and  dust,  if  there 
has  been  any  tubercular  matter  deposited 
in  the  church  or  hall.  As  they  sweep 
and  clean  pretty  often  and  at  regular  in- 
tervals, they  ultimately  accumulate  enough 
bacilli  to  overcome  resisting  power,  and 
thus  get  an  implantation. 

Janitors  and  cleaners  of  churches  and 
halls  frequently  are  victims  of  tuberculosis. 
They  no  doubt  get  the  disease  through 
their  occupation. 

People  at  large  probably  never  get 
tuberculosis  in  church  or  hall.  The  pop- 
ular fear  of  catching  the  disease  in  such 
places  has  no  foundation  in  scientific  facts. 


CHAPTER  XXVII 

Public  Conveyances 
in   the   Spread   of  Tu- 
berculosis 

FOR  the  spread  of  tuberculosis  contact 
must  be  continuous.  Casual  contact  is  not 
sufficient.  Neither  will  intermittent  con- 
tact do,  if  the  intermission  is  long  and  the 
contact  is  short. 

To  get  tuberculosis  one  must  live  with 
the  person  who  has  it,  live  in  the  place  in 
which  such  a  person  has  lived,  or  continu- 
ously use  something  which  has  been  used 
by  such  a  person  for  a  long  time. 

Even  in  the  most  fertile  contagious 
environment  one  could  scarcely  take  in 
enough  tubercle  bacilli  at  one  time  to  get 
an  implantation.     The  process  is  a   slow 

163 


164         Crusade  against  Tuberculosis 

one.  Ordinarily  the  bacilli  must  be  taken 
in  either  with  the  air  that  is  breathed  or 
the  food  that  is  eaten. 

At  every  avenue  of  entrance  there  is 
opposition  to  admission.  Nature  has 
placed  guards  at  all  ports  of  entry  to  keep 
out  disease  germs.  Within  certain  limits 
these  guards  are  competent  to  keep  out 
the  germs.  They  may  be  overpowered, 
however. 

Within  the  human  organism  there  is 
provision  also  for  fighting  off  those  disease 
germs  which  have  run  the  gauntlet  at  the 
ports  of  entry.  This  disease-fighting 
power  likewise  may  be  overcome. 

With  acute  diseases  the  number  of 
micro-organisms  given  off  ordinarily  is  so 
great  as  to  be  able  to  overcome  all  oppo- 
sition at  once.  With  tuberculosis  the 
number  given  off  is  relatively  so  small 
as  to  require  an  accumulation  to  produce 
a  contagious  environment  competent  to 
overcome  opposition. 


Conveyances  and  Tuberculosis         165 

Intermittency  of  contact  therefore  aids 
the  human  system  in  fighting  off  implanta- 
tion of  the  tubercle  bacillus.  It  gives  a 
respite  both  to  the  guards  at  the  ports  of 
entry  and  to  the  disease-fighting  soldiers 
within. 

The  length  of  time  which  ordinarily  is 
spent  in  public  conveyances  by  consump- 
tives is  insufficient  to  produce  a  fertile  con- 
tagious environment.  Such  an  environ- 
ment therefore  is  apt  to  prove  sterile,  both 
while  the  consumptive  is  in  it  and  after  he 
has  left  it. 

Even  if  the  environment  became  fertile, 
the  length  of  time  ordinarily  spent  in  it  by 
healthy  individuals  would  be  too  short 
and  too  intermittent  to  give  an  implanta- 
tion. Not  enough  tubercle  bacilli  could 
gain  admission  into  the  system  in  so  short 
a  time  to  overcome  the  disease-fighting 
power  of  the  organism. 

Carriages,  street-cars,  railway  cars,  and 
boats  of  various  kinds  are  looked  upon  by 


1 66         Crusade  against  Tuberculosis 

the  public  as  potent  factors  in  the  spread 
of  tuberculosis.  In  truth  they  count  for 
very  little. 

People  who  are  employed  in  and  about 
such  conveyances  are  remarkably  free  from 
consumption.  This  they  would  not  be  if 
the  conveyances  were  media  of  distribution 
of  the  tubercle  bacillus. 

On  railroad  lines  over  which  many  con- 
sumptives travel  to  health-resorts  there 
may  be  some  slight  danger  of  getting  im- 
plantations in  sleeping-cars.  Even  here, 
however,  the  exposure  is  ordinarily  too 
short  for  implantation. 

A  somewhat  longer  exposure  takes  place 
in  boats,  in  which  people  sometimes  spend 
weeks.  To  occupy  a  cabin  for  a  few 
weeks  with  a  consumptive  or  after  him  un- 
doubtedly gives  opportunity  for  implanta- 
tion. Even  here  the  danger  is  lessened 
by  the  time  spent  on  deck. 

Fertile  contagious  environments  really 
are   seldom   produced   in   public    convey- 


Conveyances  and  Tuberculosis         167 

ances,  even  on  boats,  except  perhaps  among 
sailors.  Among  these  the  conditions  on 
board  are  the  same  as  are  the  conditions 
among  land-people  in  their  homes. 


CHAPTER  XXVIII 

The   Chances  of 

Getting  Tuberculosis  on 

the   Street 

RAIN,  sunshine,  and  fresh  air  are  the 
natural  enemies  of  the  tubercle  bacillus. 
The  rain  disintegrates  the  tubercular  mat- 
ter, which  is  the  cache  of  the  bacillus. 
Sunshine  and  fresh  air  kill  the  bacillus. 

When  tubercular  matter  is  ejected  in  the 
open,  where  it  is  exposed  to  the  weather, 
it  soon  becomes  devitalized.  Even  when 
there  is  no  rain,  disintegration  goes  on 
rapidly  by  the  process  of  decomposition. 

How  long  it  takes  tubercular  matter  to 
become  devitalized  in  the  open  air  has  not 
been  definitely  determined.  The  proba- 
bilities are  that  it  takes  only  a  few  days,  or 
at  most  a  few  weeks. 

Even  if  it  takes  a  few  weeks,  accumula- 
tion of  tubercular  matter  on  the  street  and 

i68 


The  Street  and  Ttcberculosis  1 69 

in  the  open  to  a  degree  of  fertile  envi- 
ronment is  impossible.  It  would  take  a 
great  deal  of  tubercular  matter  to  pro- 
duce a  contagious  environment  outside. 

The  number  of  contagious  consumptives 
who  walk  the  streets  of  a  large  city  or 
who  are  in  the  open  anywhere  is,  after  all, 
relatively  small.  There  probably  is  not 
one  to  the  block,  even  in  the  poorest  and 
most  crowded  districts. 

In  large  cities  there  is  one  contagious 
consumptive  to  every  three  to  five  hundred 
people.  The  amount  of  tubercular  matter 
which  this  one  person  can  eject  while  out 
of  doors,  even  during  the  most  contagious 
period  of  his  disease,  is  of  little  conse- 
quence in  an  area  inhabited  by  so  large  a 
number  of  people. 

It  is  questionable  whether  a  consumptive 
could  produce  a  fertile  environment  out  of 
doors  even  in  the  dying  stage  of  his  dis- 
ease and  within  a  hmited  area.  The  tu- 
bercular matter  becomes  devitalized  before 


170         Crusade  against  Tuberculosis 

it  can  be  broken  up  fine  enough  to  be 
inhaled  or  be  deposited  on  food. 

Thoughtless  men  have  inflamed  the 
public  mind  with  fear  of  tuberculosis  by 
preaching  the  doctrine  of  the  ubiquity  of 
the  tubercle  bacillus.  All  outdoors,  where 
there  are  consumptives,  say  they,  is 
swarming  with  tubercle  bacilli. 

As  there  are  consumptives  everywhere, 
there  must  be  tubercle  bacilli  everywhere. 
Not  only  are  the  churches,  public  halls, 
cars,  railway  trains,  and  boats  full  of  them, 
but  the  parks,  streets,  and  public  highways 
are  swarming  with  them.  Wherever  a  con- 
sumptive goes  he  leaves  a  trail  of  them. 

How  can  it  be  otherwise  ?  A  particle 
of  tubercular  matter  the  size  of  a  pinhead 
contains  millions  of  tubercle  bacilli.  A 
consumptive  sometimes  ejects  pints  of  tu- 
bercular matter  in  a  day. 

Alas,  this  Micawber  philosophy !  There 
are  so  many  bacilli  in  a  pinhead's  worth  of 
matter;  there  must  be  so  many  in  a  pint. 


The  Street  and  Tuberculosis  171 

There  are  so  many  pints  of  matter  to  the 
consumptive,  and  so  many  consumptives 
to  the  block;  therefore  the  tubercle  bacil- 
lus must  be  everywhere. 

No  allowance  is  made  in  this  wonderful 
calculation  for  anything  except  arithmetic 
and  the  tubercle  bacillus.  Rain,  sunshine, 
fresh  air,  devitalization,  and  the  life-history 
of  the  tubercle  bacillus  count  for  nothing. 

The  tubercle  bacillus  is  not  everywhere. 
Outdoors  it  is,  relatively  speaking,  in  very 
few  places,  and  in  those  only  in  gross 
tubercular  matter.  Accumulation  of  tuber- 
cle bacilli  outdoors  is  difficult  because 
of  the  continuous  process  of  disintegration 
and  devitalization  which  goes  on  every- 
where in  the  open  air. 

Free  tubercle  bacilli  cannot  live  in  the 
open  air.  The  probabilities  are  that  they 
even  cannot  live  long  in  finely  pulverized 
tubercular  matter.  There  is  little  chance, 
therefore,  for  living  tubercle  bacilli  to  float 
about  in  the  outside  air. 


172         Crusade  against  Tuberculosis 

It  unhesitatingly  may  be  said  that  there 
is  no  chance  of  getting  tuberculosis  on  the 
street  or  in  the  open  air.  Not  enough 
living  tubercle  bacilli  can  be  taken  in  to 
give  an  implantation. 

Fear  has  been  expressed  that  women 
may  take  up  enough  tubercular  matter 
from  the  pavements  on  their  trailing  skirts 
to  contaminate  their  homes  and  produce 
fertile  contagious  environments.  Practi- 
cally this  is  impossible. 

A  woman  with  trailing  skirts  undoubt- 
edly may  pick  up  tubercular  matter  from 
the  pavement.  The  amount  which  she 
can  pick  up  in  this  way,  however,  even  if 
it  were  all  shaken  out  in  a  sleeping-room, 
would  not  produce  an  environment  fertile 
enough  to  give  implantation. 

An  environment  fertile  enough  to  give 
implantation  of  the  tubercle  bacillus  is  not 
easily  produced.  How  difficult  it  is  may 
be  inferred  from  the  relative  number  of  im- 
plantations to  environments. 


The  SU^eet  and  Tuberculosis  173 

In  a  community  in  which  occur  twenty- 
five  hundred  deaths  a  year  from  consump- 
tion there  probably  are  at  least  five  thou- 
sand contagious  cases  at  all  times.  At 
least  four  people  are  intimately  and  con- 
tinuously exposed  to  every  contagious  case. 
There  are  therefore  twenty  thousand  people 
exposed. 

Allowing  for  recovery  in  two-thirds  of 
all  the  people  who  get  the  disease,  there 
can  at  most  be  only  eight  thousand  im- 
plantations in  a  year.  This  means  that 
only  about  one  out  of  every  three  people 
who  are  exposed  even  intensely  gets  the 
disease. 


CHAPTER  XXIX 

Are    Human   and   Animal 

Tuberculosis  the 

Same  ? 

THE  discovery  of  the  tubercle  bacillus 
brought  within  reach  of  science  secrets 
about  tuberculosis  which,  without  it,  must 
have  remained  hidden.  It  did  this  by  giv- 
ing an  exact  basis  of  comparisons. 

With  the  tubercle  bacillus  as  the  basis 
of  operation  it  was  easy  to  trace  the  rami- 
fications of  tuberculosis  throughout  the 
entire  animal  kingdom.  The  disease  has 
been  searched  for  and  found  in  almost  every 
form  of  animal  life. 

One  of  the  first  places  in  which  it  was 
looked  for  and  found  was  in  cattle.  The 
disease  known  as  ^*  pearl  disease "  or 
"pearly  disease"  was  proved  to  be  tuber- 
culosis. 

174 


Hummi  a7id  Animal  Tuberculosis  175 

Investigation  moreover  brought  to  light 
the  fact  that  tuberculosis  is  a  very  common 
disease  in  cattle.  Entire  herds  were  found 
to  have  the  disease. 

Daily  herds  in  particular  were  found 
to  be  prone  to  the  disease.  The  higher 
bred  the  herd  and  the  better  the  cows 
as  milkers,  the  more  prone  they  were  found 
to  be. 

It  was  found,  too,  that  apparently  there 
was  some  relationship  between  domesticity 
of  animals  and  tuberculosis.  The  farther 
animals  were  removed  from  the  wild  state, 
the  more  prone  they  seemed  to  be  to  tuber- 
culosis. 

Some  observers  at  once  jumped  at  the 
conclusion  that  tuberculosis  in  animals  was 
due  to  association  of  the  animals  with  man. 
In  fact,  it  was  thought  that  man  gave  the 
disease  to  animals. 

Others  reversed  the  situation  and  con- 
cluded that  man  got  tuberculosis  from 
cattle.     The  fact  that  man  ate  meat  and 


176         Crusade  against  Tuberculosis 

drank  milk  was  sufficient  evidence  with 
these  to  warrant  their  conclusion. 

So  generally  did  these  latter  views  come 
to  be  held  that  measures  were  inaugurated 
all  over  the  world  for  the  suppression  of 
tuberculosis  among  cattle,  with  the  avowed 
purpose  of  stamping  out  the  disease  among 
human  beings.  Governments  took  up  the 
matter. 

Bureaus  were  estabHshed  for  the  inspec- 
tion of  dairy  herds  and  laws  were  passed 
for  the  condemnation  and  destruction  of 
cows  suffering  from  tuberculosis.  With 
the  discovery  of  tuberculin  a  refined  test 
was  furnished  by  which  incipient  cases 
could  be  searched  out. 

Herd  after  herd  of  the  finest  milk  cows 
thus  has  been  destroyed  in  the  mad  stam- 
pede to  save  human  beings  from  the  great 
white  plague.  Oftentimes,  too,  the  destruc- 
tion went  on  when  the  herd  was  healthy  to 
the  eye  but  merely  sick  to  the  tuberculin 
test. 


Human  and  Animal  Tuberculosis  177 

Alas,  that  science  should  be  such  a  lag- 
gard and  sophistry  so  fleet  of  foot!  As 
the  chasms  which  deductions  overleaped 
are  slowly  being  bridged  over  by  scientific 
research,  it  begins  to  look  as  though  iden- 
tity of  human  and  animal  tuberculosis  after 
all  does  not  necessarily  mean  intertrans- 
missibility. 

Herein  lay  the  mistake.  The  identity  of 
human  and  animal  tuberculosis  was  in- 
terpreted to  mean  intertransmissibility  as 
well.  Color  was  given  to  this  deduction 
by  the  close  relationship  between  man  and 
domestic  animals. 

Once  having  jumped  at  the  conclusion, 
it  was  easy  to  find  arguments  to  support  it. 
Plausible  evidence  was  at  hand  everywhere. 

Man  and  the  cow  were  most  afflicted  with 

tuberculosis.     They    were   interdependent. 

The  consumptive  dairyman  gave  the  cow 

tuberculosis.     The  consumptive  cow  gave 

milk  and  meat  to  man.    What  more  natural 

than  that  she  should  give  him  tuberculosis? 
12 


178  Crusade  against  Tuberculosis 

Gradually  science  is  clearing  up  the 
whole  matter,  although  the  last  word  can- 
not be  spoken  as  yet  by  any  means.  So  far 
as  exact  knowledge  goes,  it  looks  as  though 
the  deductions  which  have  been  made  were 
premature. 

So  much  only  is  certain :  the  tubercle 
bacillus  which  grows  in  the  human  body 
and  the  tubercle  bacillus  which  grows  in 
animals  undoubtedly  are  one  and  the  same 
micro-organism  modified  by  the  soil  on 
which  they  grow. 

The  modification  is  shown  in  form,  in 
virulence,  and  in  predilection  for  soil.  Perhaps 
more  exact  knowledge  of  these  modifica- 
tions may  some  time  later  bring  us  the 
power  of  identifying  soil  by  the  bacillus 
itself 

It  is  pretty  well  settled,  too,  that  the 
tubercle  bacillus  by  the  modifications 
which  it  undergoes  becomes  indigenous  to 
the  soil  on  which  it  grows.  When  it 
has  grown  on  a  certain  soil  for  a  certain 


Human  and  Animal  Tuberculosis  1 79 

time,  it  apparently  loses  its  adaptability  to 
other  soils. 

It  is  true  that  the  bacillus  which  has 
become  indigenous  to  human  soil  can  be 
made  to  grow  on  animal  soil.  It  does  not 
take  root  readily,  however,  and  it  grows 
poorly  when  it  has  taken  root. 

Many  experiments  have  been  made  on 
all  kinds  of  animals  to  elucidate  this  sub- 
ject. In  all  it  has  been  evident  that  ani- 
mals are  not  congenial  soil  for  human 
tubercle  bacilli. 

It  has  not  been  possible,  on  the  other 
hand,  to  make  experiments  to  test  the  con- 
geniality of  human  soil  for  animal  tubercle 
bacilli.  But  in  a  few  instances  accident 
has  supplied  the  information  which  such 
experiments  would  give. 

Veterinary  surgeons  and  butchers  have 
accidentally  Inoculated  themselves  with  ani- 
mal tuberculosis.  The  growth  which  has 
followed  such  inoculation  has  in  every  in- 
stance been  benign. 


i8o  Crusade  against  Tuberculosis 

All  of  the  cases  recorded  recovered 
upon  excision  of  the  growth.  In  one  case 
only  did  death  occur,  and  in  this  it  was 
uncertain  whether  or  not  the  person  had 
been  exposed  to  contagion  of  human  tuber- 
culosis. 

Human  and  animal  tuberculosis  undoubt- 
edly are  one  and  the  same  disease.  They 
are  intertransmissible  by  artificial  methods ; 
but  they  probably  seldom  are  intertrans- 
mitted  in  the  natural  way. 


CHAPTER  XXX 

Tuberculosis   from 
Meat  and  Milk 

MAN  is  an  omniverous  being.  He  can  eat 
all  kinds  of  food.  By  nature  he  is  a  meat- 
eater  as  well  as  a  grain-eater  and  a  grass- 
eater. 

Meat  at  all  times  has  been  an  important 
article  of  diet  for  him.  It  has  stood  next 
to  bread  as  a  staple. 

Milk  is  the  food  of  children  and  invalids. 
It  is  the  staff  of  life  to  the  young  and  the 
weak. 

For  the  sick  it  is  more  than  medicine. 
It  is  the  one  food  upon  which  the  crippled 
organism,  when  sick,  can  be  coaxed  back 
to  health. 

Meat  and  milk  are  too  important  in  the 
human  dietary  to  be  stigmatized  without 
reason.     They  should  not  be  libeled. 

i8i 


1 82  Crusade  against  Tuberculosis 

The  advocates  of  radical  measures  for 
eradication  of  tuberculosis  among  cattle 
have  unsettled  the  public  mind  about  the 
consumption  of  meat  and  milk.  Many- 
people  are  afraid  to  use  them  any  longer. 

The  movement  to  eradicate  tuberculosis 
from  dairy  herds  is  one  which  merits  unani- 
mous support.  There  has  been  a  mistake 
made,  however,  in  predicating  it  upon 
eradication  of  tuberculosis  from  the  human 
race.     It  should  stand  on  its  own  merits. 

Whether  meat  and  milk  can  be  media  of 
conveying  animal  tuberculosis  to  human 
beings  is  still  a  mooted  question.  In  the 
light  of  our  present  knowledge  we  can 
only  say  :  theoretically,  they  can  be;  prac- 
tically, probably  they  are  not. 

Meat  as  eaten  usually  consists  of  the 
muscular  tissue  of  an  animal.  Muscular 
tissue  never  is  the  seat  of  tuberculosis. 
Muscular  juice,  however,  may  contain  tu- 
bercle bacilli.  The  bacilli  probably  are  in 
the    blood.     The    number    thus    situated 


Meat  and  Milk  183 

necessarily  must  be  relatively  small,  how- 
ever. 

Meat  as  a  rule  is  washed  and  cooked 
before  being  eaten.  When  eaten  raw,  it 
usually  is  first  put  through  a  process  of 
drying,  pickling,  or  smoking.  Any  of  the 
processes  of  preparing  meat  for  eating 
probably  attenuates  tubercle  bacilli  if  it 
does  not  kill  them. 

Milk  is  more  likely  to  contain  tubercle 
bacilli  than  is  meat.  Even  milk,  however, 
relatively  is  little  exposed  to  contamination. 

Milk,  being  a  secretion,  is  protected 
against  contamination  unless  the  udder  of 
the  cow  is  diseased.  Tuberculosis  of  the 
udder  is  rare.  When  it  occurs,  the  cow 
becomes  useless  as  a  milker  and  is  apt  to 
be  discarded. 

Advanced  tuberculosis  of  any  form  seri- 
ously cripples  the  cow  as  a  milker.  All 
such  cows  usually  are  removed  from  dairy 
herds  because  they  no  longer  are  worth 
keeping. 


184  Crusade  against  Tuberculosis 

It  has  been  proved  by  inoculation  experi- 
ments that  tubercular  milk  diluted  one  to 
fifty  becomes  sterile.  One  cow  with  tuber- 
culosis of  the  udder  in  a  herd,  therefore, 
probably  would  not  contaminate  the  milk 
sufficiently  to  give  implantations,  even 
under  the  most  favorable  circumstances. 

Feeding  experiments  with  tuberculous 
meat  and  milk  have  been  made  on  suscepti- 
ble animals.  The  results  were  about  one 
implantation  for  every  three  animals  fed. 

The  gastric  juice  has  an  attenuating  in- 
fluence on  the  tubercle  bacillus.  Bacilli 
which  have  been  subjected  to  the  gastric 
juice  do  not  take  root  well  and  have  poor 
growth. 

Meat  and  milk  which  contain  tubercle 
bacilli  therefore  undergo  a  further  reduc- 
tion of  fertility  by  the  process  of  digestion. 
They  indeed  may  be  made  absolutely 
sterile. 

The  feeding  and  inoculation  experiments 
were  made  on  animals  which  are  quite  sus- 


Meat  and  Milk  185 


ceptible  to  animal  tubercle  bacilli.  Human 
beings  probably  are  not  susceptible  to  ani- 
mal tubercle  bacilli. 

At  most,  therefore,  human  beings  would 
not  be  more  likely  to  get  tuberculosis  from 
the  use  of  meat  and  milk  than  are  animals. 
All  the  facts  at  our  command  seem  to  indi- 
cate that  they  would  be  much  less  likely  to 
do  so. 

When  animals  have  been  fed  tuberculous 
meat  and  milk  for  experimental  purposes, 
they  moreover  have  been  kept  on  such  diet 
constantly,  and  the  meat  and  milk  have 
been  selected  on  account  of  their  tuber- 
culous qualities.  In  practical  life,  with 
human  beings,  tuberculous  meat  and  milk 
are  never  taken  as  a  steady  diet,  nor  are 
they  selected  for  their  tuberculous  qualities. 

Perhaps  the  strongest  argument,  how- 
ever, which  can  be  advanced  against  the 
view  that  meat  and  milk  are  a  source  of 
seed  supply  for  human  tuberculosis  is  to  be 
found  in  clinical  experience.    No  indisputa- 


1 86         Crusade  against  Tuberculosis 

ble  case  has  been  put  on  record  in  which 
human  tuberculosis  has  been  contracted  by 
the  use  of  meat  and  milk. 

A  few  cases  have  been  recorded  which 
were  believed  to  have  been  contracted  in 
this  way.  In  none  of  them,  however,  was 
there  more  than  circumstantial  evidence, 
and  in  none  could  contagion  from  human 
sources  be  excluded. 

So  far  as  milk  is  concerned  a  strong 
argument  against  the  view  is  at  hand  in 
the  low  death-rate  from  tuberculosis  in 
childhood.  The  lowest  death-rate  from 
tuberculosis  is  during  the  age  period  when 
children  are  most  dependent  on  cow's  milk 
for  their  food. 

In  the  light  of  our  present  knowledge, 
therefore,  it  unhesitatingly  may  be  said 
that  there  is  practically  no  danger  of  get- 
ting tuberculosis  from  the  use  of  meat  and 
milk.  It  even  is  quite  possible  that  a  lib- 
eral use  of  these  articles  of  diet  gives  a  cer- 
tain protection  against  the  disease. 


CHAPTER  XXXI 

How  the  Tubercle 

Bacillus  Gets  into  the 

System 

IT  IS  well  understood  how  the  tubercle 
bacillus  gets  out  of  the  system.  Science 
has  had  ample  opportunity  of  studying  this. 
The  entire  process  lies  before  us  like  an 
open  book. 

Not  so  with  the  entrance  of  the  tubercle 
bacillus  into  the  system.  Much  of  our 
knowledge  upon  this  subject  is  theoretical. 
We  know  how  it  may  occur,  but  we  do  not 
know  exactly  how  it  does  occur. 

Experiments  on  animals  have  shown  that 
the  tubercle  bacillus  may  enter  by  the  skin, 
by  the  lungs,  and  by  the  stomach.  Ani- 
mals have  been  inoculated  with  tubercular 
matter,  have  been  made   to   inhale  it,  and 

187 


1 88  Crusade  against  Tuberculosis 

have  been  fed  on  it.     All  of  the  methods 
have  given  implantations. 

It  is  believed  that  in  human  beings  en- 
trance takes  place  by  all  three  methods. 
Entrance  by  the  skin,  however,  is  believed 
to  be  exceptional,  and  to  occur  only  when 
an  abrasion  exists. 

Entrance  by  the  lungs  is  regarded  as  the 
most  frequent  method.  This  view  no  doubt 
has  been  accepted  partly  because  the  lungs 
most  frequently  are  the  seat  in  which  tuber- 
culosis is  first  detected. 

Entrance  by  the  stomach  likewise  is 
looked  upon  as  a  frequent  method.  In 
more  recent  years  it  is  given  first  place  in 
the  order  of  frequency  by  many  observers. 

At  all  oi  these  ports  of  entry  nature  has 
placed  obstacles  to  the  admission  of  disease 
germs.  These  obstacles  are  greater  or 
smaller  according  to  the  openness  of  the 
port. 

In  the  skin  the  lymphatic  system  stands 
guard.     When  the   skin  is  broken  and  dis- 


How  the  Bacillus  Gets  in  189 

ease  germs  get  into  the  wound,  the  lymph- 
atics, which  are  small  vessels,  at  once 
gather  them  up  and  carry  them  into  the 
nearest  gland,  there  to  destroy  them  if 
possible. 

If  the  number  of  disease  germs  is  large 
or  if  they  multiply  very  rapidly,  they  over- 
come the  guards  and  spread  throughout 
the  system.  With  acute  diseases  this  usually 
is  the  case. 

When  the  tubercle  bacillus  enters  by  the 
skin,  it  seldom  gets  far  beyond  the  port  of 
entry.  From  its  first  location,  however,  it 
may  spread  to  other  parts. 

At  the  port  of  entry  by  way  of  the  lungs 
nature  has  placed  many  obstacles,  prob- 
ably because  it  always  is  open.  We 
breathe  all  the  time,  by  night  and  by  day, 
and  in  all  kinds  of  places. 

The  lungs  are  meant  by  nature  to  admit 
gaseous  substances  only.  Nature  therefore 
has  so  formed  and  shaped  the  nose  and 
throat  as  to  obstruct  solid  matter  at  every 
turn. 


190         Crusade  against  Tttberculosis 

She  moreover  has  placed  stiff  hairs  inside 
of  the  nose  to  act  as  a  sieve,  and  has  dotted 
the  mucous  membrane  with  glands  which 
secrete  a  viscid  mucus  to  carry  off  solid 
matters  that  may  be  deposited  on  the  mem- 
brane. 

All  along  the  respiratory  tract  she  has 
paved  the  mucous  membrane  with  small 
cells  which  have  tiny  little  arms  or  antennae. 
All  of  these  move  outwards  so  as  to  be 
able  to  carry  out  solid  matter. 

All  along  this  tract,  too,  there  are  thou- 
sands of  little  mouths  which  empty  into  the 
lymphatic  vessels.  These  little  mouths 
suck  up  any  solid  matter  which  may  have 
entered  and  have  escaped  ejection. 

Tubercular  matter,  to  get  in  by  way  of 
the  lungs,  must  be  finely  pulverized.  It 
cannot  go  in  unless  it  is.  It  must  be  so 
impalpable  as  to  be  readily  suspended  in  the 
air. 

Most  of  the  matter  which  goes  in  with 
the  air  is  deposited  on  the  mucous  mem- 


How  the  Bacillus  Gets  in  191 

brane  of  the  respiratory  tract,  and  is  again 
ejected  with  mucus.  Some  finds  its  way 
far  down  into  the  bronchial  tubes,  how- 
ever, and  resists  ejection. 

The  matter  which  remains  in  the  tubes  is 
disintegrated  by  the  mucus,  is  taken  up  by 
the  lymphatic  mouths,  and  is  carried  into 
the  lymphatic  glands,  which  are  numerously 
located  alongside  of  the  bronchial  tubes. 
Here  the  tubercle  bacilli,  having  been  shelled 
out  of  their  hulls,  so  to  speak,  are  ready  to 
germinate. 

The  lymphatic  glands  are  believed  to 
possess  the  power  of  destroying  disease 
germs.  The  disease-fighting  power  of 
these  glands  may  be  overcome,  however. 
Then  a  colony  forms  and  the  tuberculosis 
begins. 

When  the  tubercle  bacillus  enters  the 
system  by  way  of  the  lungs,  the  beginning 
of  the  tubercular  process  is  always  in  the 
bronchial  glands.  From  these  glands  the 
process  extends  to  the  lung  tissue  itself 


192         Crusade  against  Tuberculosis 

The  struggle  of  the  system  against  col- 
onization of  tubercle  bacilli  may  go  on  for 
years  in  the  bronchial  glands,  without  symp- 
toms, before  victory  is  gained  for  one  side 
or  the  other.  Tubercle  bacilli  which  gain  ad- 
mission into  the  glands  in  childhood  may  col- 
onize only  in  adult  life,  and  even  in  old  age. 

The  port  of  entry  by  way  of  the  stomach 
also  is  well  guarded  against  admission  of 
disease  germs,  but  not  as  well  as  that  by  way 
of  the  lungs.  The  stomach  is  the  natural 
port  of  entry  for  solids,  and  tubercular 
matter  is  solid  matter. 

When  tubercular  matter  is  mixed  with 
food  it  gets  into  the  stomach  with  the  food. 
When  it  is  deposited  on  the  mucous  mem- 
brane of  the  throat  during  respiration,  it 
is  carried  down  into  the  stomach  with 
food  and  drink. 

In  the  stomach  the  tubercle  bacillus  meets 
its  first  obstacle  at  this  port.  It  has 
to  run  the  gauntlet  of  the  gastric  juice, 
which  has  some  germicidal  qualities. 


How  the  Bacillus  Gets  in  193 

It  has  been  proved  by  experiment,  how- 
ever, that  tubercle  bacilh  sometimes  are 
merely  weakened  by  the  gastric  juice  and 
not  destroyed.  When  digestion  is  weak, 
they  even  may  escape  injury  altogether. 

Very  few  people  have  perfect  digestion 
all  the  time.  There  are  times,  therefore, 
with  every  one  when  the  tubercle  bacillus 
may  pass  through  the  stomach  unharmed. 

Many  times,  no  doubt,  the  gastric  juice 
merely  serves  to  disintegrate  tubercular 
matter  and  set  the  tubercle  bacilli  free  from 
their  cache.  The  bacilli  thus  get  into  the 
intestines  hulled  and  ready  for  germina- 
tion. 

In  the  intestines  the  bacilli  still  are  out- 
side of  the  system  and  outside  of  con- 
genial soil,  however.  They  still  must  run 
the  gauntlet  of  the  little  mouths  which  suck 
up  the  food  particles  and  which  have  cer- 
tain powers  of  selection. 

That  tubercle  bacilli,  however,  may  be 
taken  up  by  these  little  mouths  with   the 

13 


194  Crusade  against  Tuberculosis 

food  particles  and  thus  get  into  the  circula- 
tion cannot  be  doubted.  Physiologically 
the  alimentary  canal  is  the  shortest  route 
into  the  circulation  from  the  outside  world 
for  solids. 

When  there  is  an  erosion  of  any  kind  in 
the  mucous  membrane  of  the  intestines,  the 
bacilli  may  be  taken  up  by  the  lymphatics 
of  the  intestines  and  carried  into  the  mesen- 
teric glands.  This  no  doubt  frequently 
happens,  especially  among  children. 

We  then  have  what  is  called  marasmus 
or  inanition.  The  child  wastes  away  with- 
out any  apparent  cause. 

When  the  tubercle  bacillus  gets  into  the 
system  by  way  of  the  stomach,  it  may  be 
carried  by  the  blood  to  any  part  of  the  body 
before  it  finds  a  resting-place  and  a  proper 
soil  for  germination  and  growth.  When  it 
finds  such  a  place,  it  colonizes  and  we  have 
the  beginning  of  tuberculosis. 

This  is  why  we  may  have  tuberculosis 
primarily  in  any  part  of  the  body  which  has 


How  the  Bacillus  Gets  in  195 

a  blood-supply.  The  part  of  the  body 
which  is  the  point  of  least  resistance  offers 
the  resting-place  and  the  congenial  soil  for 
the  tubercle  bacillus. 


CHAPTER  XXXII 

The   Natural   Course 
of  Tuberculosis 

TUBERCULOSIS  is  a  tedious,  long- 
drawn-out  disease,  slow  in  its  inception, 
slow  in  its  development,  and  slow  in  its 
termination.  It  is  slow  and  tedious  be- 
cause it  is  local,  and  does  not  poison  the 
nervous  system  rapidly  and  intensely. 

It  always  begins  in  a  small  way,  and 
gradually  extends,  gathering  strength  as  it 
goes.  It  gives  off  a  little  poison  all  the 
time,  but  not  enough  to  create  much  dis- 
turbance. It  apparently  soothes  the  ner- 
vous system  into  tolerance  as  it  goes. 

Like  the  ivy  which  climbs  up  the  side  of 
the  house,  it  begins  as  a  mere  speck,  but 
extends  and  gains  in  rapidity  as  it  grows. 
In  the  end  it  destroys  so  much  tissue  as  to 
make  the  body  unfit  for  life. 

196 


Course  of  Tuberculosis  197 

After  certain  progress  it  assumes  a  form 
which  materially  differs  from  that  under 
which  it  begins.  Under  this  new  form  it  is 
known  as  consumption.  Its  course,  there- 
fore, may  be  divided  into  two  epochs. 

As  consumption  it  terminates  its  exist- 
ence with  the  death  of  its  victim.  It 
gives  off  the  seed  which  is  to  be  sown  on 
other  soil. 

During  the  first  epoch  it  rarely  is  recog- 
nized. The  symptoms  are  so  insignificant 
that  the  victim  does  not,  as  a  rule,  consult 
a  physician. 

He  may  realize  that  he  is  not  in  good 
health.  His  family  and  friends  may  com- 
ment on  his  not  looking  well,  on  his 
getting  thin,  and  his  not  being  himself 

He  easily  explains  all  these  matters  to 
himself,  however.  He  has  been  doing 
extra  work,  he  has  had  some  unusual 
annoyances  or  some  great  worry.  All  will 
come  right  when  he  gets  through  with  his 
rush  or  when  his  mind  has  been  relieved. 


198  Crusade  against  Tuberculosis 

If  his  appetite  is  poor,  he  blames  it  on 
his  food  or  on  the  cook  perhaps.  He 
recalls  that  he  has  been  overloading  his 
stomach  lately.  All  he  needs  is  to  be 
careful  about  his  diet  for  a  while. 

If  he  finds  himself  a  little  feverish  and 
flushed  at  times,  it  is  because  he  has  been 
unduly  excited,  has  taken  a  little  cold, 
or  has  overworked  himself  a  trifle.  If  he 
is  chilly,  the  weather  or  his  clothes  are  at 
fault. 

If  he  is  unusually  fatigued  or  has  pain, 
he  is  getting  rheumatism  or  has  malaria, 
he  is  working  too  hard,  or  the  weather  is 
unseasonable.  These  things  will  all  come 
right  in  a  little  while,  he  knows. 

This  abnormal  condition,  which  is  neither 
health  nor  disease,  goes  on  indefinitely,  a 
little  better  now  and  a  little  worse  again. 
It  is  not  bad  enough  to  warrant  inter- 
ference, and  usually  a  physician  is  not  con- 
sulted unless  a  cold,  influenza,  pneumonia, 
pleurisy,  or  some  other  disease  intervenes. 


Course  of  Tuberculosis  199 

Even  an  intercurrent  disease  may  not 
bring  the  tuberculosis  to  light.  The  phy- 
sician's attention  is  so  riveted  on  the  in- 
tercurrent trouble  that  he  cannot  see  be- 
yond it.  He  is  able  to  explain  all  the 
symptoms  satisfactorily  to  himself  by  the 
intercurrent  disease. 

Self-deception  is  quite  easy  in  these 
cases  because  the  intercurrent  disease 
cloaks  the  tubercular  process.  The  tuber- 
culosis really  must  be  looked  for  to  be 
found. 

After  the  intercurrent  disease  has  passed 
off,  health  seems  to  be  better.  Contrast 
probably  makes  it  appear  so.  This  still 
further  deceives  the  victim. 

Quietly  the  tuberculosis  goes  on  ex- 
tending further  and  further  into  healthy 
tissue.  Bad  health  has  become  the  ordi- 
nary condition  and  no  longer  arrests  atten- 
tion. Intercurrent  diseases  produce  tem- 
porary alarm,  which  subsides  as  they  pass 
off 


200         Crusade  against  Tube^^culosis 

The  duration  of  the  first  epoch  varies 
with  different  individuals.  It  may  be  a  few- 
years,  it  may  be  a  lifetime.  It  seldom  is 
less  than  a  few  years. 

Transition  into  the  second  epoch  may 
be  sudden  or  gradual.  Occasionally  it  is 
by  a  violent  outburst  of  illness  with  severe 
chills,  high  fever,  and  terrible  sweats. 

This  is  called  galloping  consumption. 
The  sickness  comes  as  though  it  dropped 
from  heaven  and  runs  through  its  course 
like  a  whirlwind.  Under  these  circum- 
stances the  poor  health  epoch  usually  is 
lost  sight  of  in  the  virulence  of  the  subse- 
quent attack. 

The  tuberculosis  really  had  existed  for 
years  unrecognized.  It  was  in  some 
obscure  corner  of  the  body,  perhaps  in 
some  lymphatic  gland. 

The  small  patch  ripened,  the  seed  was 
emptied  into  the  circulation,  it  was 
sown  in  every  part  of  the  body,  and 
such  a  tremendous  crop  sprung  up  as  to 


Course  of  Tuber czclosis  201 

poison  the  nervous  system  and  destroy 
life  at  once. 

Such  universal  growth  probably  occurs 
in  persons  only  who  have  a  strong  predis- 
position to  the  disease.  In  proportion  as 
there  is  immunity,  extension  of  the  disease 
from  the  first  little  spot  is  slow. 

In  persons  who  have  strong  immunity, 
recovery  frequently  takes  place  during  the 
first  epoch  without  it  being  discovered  that 
they  have  the  disease.  The  tendency  to 
recovery  is  very  strong. 

Ordinarily,  the  second  epoch  comes  on 
in  mild  form  and  is  ushered  in  by  a  severe 
intercurrent  disease,  such  as  pneumonia, 
pleurisy,  or  influenza.  The  intercurrent 
disease  does  not  end  in  recovery,  but 
gradually  fades  into  consumption. 

To  the  lay  mind  the  intercurrent  disease 
has  turned  into  consumption.  In  reality  it 
only  has  been  the  cabinet  in  which  the 
tuberculosis  transformed  itself  into  con- 
sumption. 


202  Crusade  against  Tuberculosis 

Sometimes  the  transformation  from 
tuberculosis  into  consumption  is  more 
gradual  and  less  dramatic.  In  such  cases 
it  usually  takes  place  under  cover  of  a 
cold. 

The  symptoms  of  consumption  are  well 
recognized.  They  are  chills,  fever,  sweats, 
cough,  expectoration,  emaciation,  loss  of 
appetite,  and  extreme  weakness. 

These  symptoms  continue  in  milder  or 
severer  form,  with  occasional  intermissions, 
throughout  the  entire  second  epoch. 
When  the  intermissions  are  long,  as  they 
sometimes  are,  there  is  some  improvement. 

The  tendency,  however,  is  always  down- 
ward. From  one  exacerbation  to  another, 
as  the  severe  attacks  are  called,  each  is  a 
rung  lower  in  the  ladder  of  health.  Ulti- 
mately an  attack  proves  fatal. 

The  duration  of  the  second  epoch  is 
from  six  months  to  as  many  years.  The 
dying  end  of  it  usually  is  about  two 
months. 


CHAPTER    XXXIII 

Tuberculosis    is    a 
Curable   Disease 

HIPPOCRATES  twenty-five  hundred 
years  ago  said  that  all  consumptives  die. 
The  world  has  kept  on  saying  the  same 
thing  ever  since.  Even  the  medical  pro- 
fession, as  a  body,  has  subscribed  to  the 
verdict. 

The  verdict  is  wrong.  It  is  based  on 
incomplete  evidence.  It  was  reached  at 
the  bedside  of  the  dying  consumptive. 

Hippocrates  did  not  know  tuberculosis 
except  in  the  form  of  consumption.  He 
did  not  recognize  the  disease  in  its  larval 
and  chrysalis  stages,  but  only  when  it 
was  a  full-fledged  butterfly. 

His  conclusions  were  based  on  dying 
cases.  Of  the  dying  stage  of  the  disease 
his  verdict  still  holds  good  and  ever  will, 

203 


204  Crusade  against  Tuberculosis 

because  the  disease  does  not  prove  fatal 
until  so  much  tissue  has  been  destroyed 
that  life  is  no  longer  possible. 

The  world  has  accepted  Hippocrates' 
verdict  because  it  has  been  able  to  verify 
it  at  the  bedside  of  the  dying  consumptive. 
No  one  has  seen  a  dying  consumptive 
get  well,  therefore  tuberculosis  always  is 
fatal.      Such  is  the  reasoning. 

When  a  person  with  symptoms  of  tu- 
berculosis has  recovered,  it  has  been  ac- 
cepted as  evidence  that  he  did  not  have 
tuberculosis.  A  consumptive  cannot  re- 
cover ;  therefore  a  person  who  has  recov- 
ered could  not  have  had  consumption. 

From  time  immemorial  the  medical  pro- 
fession, as  a  body,  has  abandoned  the  con- 
sumptive to  his  fate.  It  has  smoothed 
his  downward  path  with  palliatives  and 
has  kept  him  in  bhssful  ignorance  of  his 
doom. 

To  pretend  to  be  able  to  arrest  that 
downward   course   and    to    suggest    meas- 


ruberctdosis  is  Cttrable  205 

ures  for  such  an  end  were  cried  down  as 
braggadocio  and  heresy.  Men  who  did 
such  things  were  shunned  by  their 
brethren. 

Here  and  there  in  the  history  of  medi- 
cine stands  out  a  man  who  held  out  hope. 
He  was  as  one  crying  in  the  wilderness, 
however,  and  he  went  down  in  oblivion. 
He  was  forgotten  with  his  generation, 
and  the  verdict  of  Hippocrates  lived  on. 

With  more  exact  knowledge  of  the 
cause  of  consumption  and  of  the  course 
of  the  disease  from  its  beginning  to  its 
end  science  has  at  last  convicted  Hip- 
pocrates of  his  error.  It  remains  to  con- 
vince his  followers. 

Tuberculosis  is  one  of  the  most  curable 
of  all  diseases.  The  tendency  to  recovery 
is  so  great  that  even  without  medical 
aid  and  in  spite  of  disregard  of  all  laws 
of  nature  more  cases  recover  than  end 
fatally. 

Among    the    very  poor   in    large    cities 


2o6  Crusade  against  Tube7'CMlosis 

nearly  every  one  gets  tuberculosis.  About 
one-third  of  all  who  get  the  disease  die 
of  it.  The  others  when  they  die  show 
evidence  of  having  had  it  and  of  having 
recovered.  This  has  been  demonstrated  on 
the  autopsy  table  in  charity  hospitals. 

The  discovery  of  the  tubercle  bacillus 
has  brought  us  clinical  proof  also  of  the 
curability  of  tuberculosis.  It  now  no 
longer  can  be  said  that  recovery  is  an  evi- 
dence that  tuberculosis  did  not  exist,  be- 
cause the  existence  of  tuberculosis  is 
proved  by  the  presence  of  the  tubercle 
bacillus. 

Living  examples  of  cured  consumptives, 
in  whom  the  diagnosis  has  been  scien- 
tifically established,  are  now  to  be  en- 
countered everywhere.  The  process  of 
cure,  moreover,  can  be  seen  on  a  large 
scale  in  sanatoria  in  every  part  of  the 
world. 

Seeing  is  believing  with  most  people. 
Every    cured     consumptive    becomes     an 


Tuberculosis  is  Curable  207 

apostle  of  the  new  doctrine  among  the 
people  with  whom  he  associates.  He 
raises  the  banner  of  hope. 

Advanced  medical  science  now  holds 
out  a  strong  helping  hand  to  nature  in 
its  efforts  to  cure  tuberculosis.  Much 
has  been  learned  about  the  treatment  of 
the  disease. 

In  the  incipient  stage  practically  all 
cases  can  be  cured — the  majority  even 
without  leaving  home  or  giving  up  employ- 
ment. Relatively  few,  however,  are  dis- 
covered early  enough  for  this. 

In  more  advanced  stages  the  majority 
can  be  cured  if  proper  conditions  for 
treatment  can  be  established,  and  can  be 
maintained  for  a  long  enough  period  of 
time.  Among  the  poor  these  conditions 
can  only  be  established  in  sanatoria. 

How  far  the  disease  must  be  advanced 
before  it  becomes  hopeless  cannot  be  de- 
termined definitely  at  the  present  time. 
Much  depends    upon  how  much  tissue  is 


2o8         Crusade  against  Tuberculosis 

involved.  When  a  number  of  organs  of 
the  body  are  affected  and  much  tissue 
has  been  damaged,  the  case  is  hopeless. 
In  a  general  way,  loss  of  body-weight 
gives  a  fair  guide  by  which  to  gauge  the 
chances  of  recovery.  Loss  of  one-third 
of  the  body-weight  is  very  near  the  point 
where  all  chance  of  recovery  ends. 


CHAPTER  XXXIV 

The   Treatment   of 
Consumption 

SCIENTIFIC  medicine  no  longer  can  be 
reproached  with  helplessness  in  combating 
consumption.  It  now  places  at  the  com- 
mand of  the  physician  an  extensive  arma- 
mentarium of  efficient,  well-tried  weapons. 

As  yet  there  is  no  specific  remedy  for 
the  disease ;  that  is,  there  is  no  one  remedy 
which  will  cure  it  every  time.  There  are, 
however,  many  remedies  which  when  skil- 
fully used  at  the  proper  time  help  nature 
to  win  the  victory  in  her  struggle  against 
the  disease. 

The  treatment  of  consumption,  accord- 
ing to  modern  ideas,  consists  in  seeking 
to  restore  the  entire  organism  which  is 
upset  by  the  disease  to  normal  physio- 
^*  209 


2IO  ^      Crusade  against  Tuberculosis 

logical  action.  Whatever  is  deficient  is 
made  efficient. 

This  may  be  quite  a  complicated  task. 
Every  organ  in  the  body  may  be  deranged 
from  one  cause  or  another. 

There  is  a  slow  poisoning  of  the  nervous 
system,  by  the  toxin  of  the  micro-organ- 
isms. This  poisoning  stimulates  some 
functions  and  depresses  others.  That 
which  is  overacting  must  be  brought 
down,  and  that  which  is  underacting  must 
be  brought  up. 

The  local  irritation  set  up  by  the  growth 
of  the  micro-organisms  causes  disturbance 
and  interferes  with  function.  This  disturb- 
ance and  interference  may  extend  even  to 
neighboring  organs. 

One  and  the  same  nerve,  for  example, 
supplies  both  the  lungs  and  the  stomach. 
Irritation  of  the  end  of  the  nerve  in  one 
organ  may  disturb  the  function  of  the 
other  organ. 

Tuberculosis  of  the  lungs  therefore  may 


The  Treatment  of  Consumption      2 1 1 

seriously  interfere  with  the  functions  of  the 
stomach ;  and  overburdening  the  stomach 
with  indigestible  food  may  greatly  handi- 
cap the  struggling  lung. 

The  stomach  must  be  aided  where  it  is 
handicapped  and  the  lungs  must  be  spared 
in  the  rush  for  nutrition.  As  much  nu- 
trition as  possible  with  as  little  irritation  as 
possible  is  the  motto. 

The  growth  of  micro-organisms  in  the 
tissues  of  the  body  also  interferes  with 
the  circulation  of  the  blood.  There  is  an 
impediment  to  the  free  passage  of  the 
blood,  and  the  heart  has  to  do  extra 
work. 

Overaction  of  the  heart  may  cause  rup- 
ture of  blood-vessels  in  the  lungs  and 
bring  on  hemorrhage.  It  also  may  stimu- 
late extension  of  the  tubercular  process. 

The  burdens  of  the  heart  therefore  must 
be  lightened  so  that  the  circulation  may 
be  kept  within  normal  limits.  The  nor- 
mal labors  of  the  heart  must  be  reduced 


212  Crusade  against  Tuberculosis 

to  compensate  for  the  abnormal  demands 
upon  it. 

The  treatment  of  tuberculosis  is  not  a 
matter  of  giving  drugs  so  much  as  regu- 
lating the  patient's  life.  Every  action  of 
the  patient  must  be  brought  under  control. 

Not  that  drugs  are  useless.  Many- 
drugs  are  of  value  in  regulating  the  ab- 
normal action  of  disturbed  organs  of  the 
body  and  bringing  them  back  to  normal 
functions.  They  must  be  used  only  when 
needed,  however. 

Taking  drugs  for  the  sake  of  doing 
something  should  be  carefully  avoided. 
Drugs  may  do  harm  as  well  as  good.  No 
drug  should  be  used  unless  for  a  well- 
defined  reason. 

Close  attention  to  details  is  the  key  to 
success  in  the  treatment  of  consumption. 
Everything  in  the  life  of  the  patient  must 
be  shaped  to  one  end — normal  physiolog- 
ical action  of  every  function  of  the  body. 

Whatever  makes  for  nutrition  makes  for 


The  Treatment  of  Consumption       213 

recovery;  whatever  interferes  with  nutri- 
tion helps  the  disease.  The  nutritive  sys- 
tem is  nature's  laboratory  for  the  manufac- 
ture of  its  germicides. 

Nutrition  depends  upon  three  factors — 
food,  air,  and  expenditure  of  energy.  The 
treatment  of  tuberculosis  therefore  hing-es 
largely  upon  a  sufficient  amount  of  proper 
food,  upon  fresh  air,  and  upon  regulation 
of  rest  and  exercise. 


CHAPTER  XXXV 

Food  in  the  Treatment 
of  Consumption 

CONSUMPTION  is  a  wasting  disease. 
Its  most  striking  feature  is  loss  of  tissue. 
Hence  its  name. 

First  the  fat  of  the  body  disappears. 
Then  the  muscles  begin  to  dwindle.  The 
skin  gets  pale  and  the  whole  body  de- 
generates. 

Waste  in  consumption  probably  is  due  in 
part  to  interference  with  nutrition  through 
poisoning  of  the  nervous  system,  and  in 
part  to  destruction  of  cells  in  the  fight 
against  disease.  In  part  it  also  may  be 
due  to  diversion  of  food  from  the  tissues 
to  the  micro-organisms. 

The  tubercle  bacillus,  by  the  poison 
which  it   gives    off  and  by  the   irritation 


Food  in  Consumption  215 

which  it  sets  up,  starts  vicious  circles  of 
debasement  in  the  body  for  its  own  good 
and  the  good  of  its  associate  micro-or- 
ganisms. 

The  poisoned  nervous  system  inter- 
feres with  nutrition.  Badly  nourished 
organs  do  inferior  work.  Bad  work  leads 
to  deterioration  of  the  body.  The  dam- 
aged body  becomes  more  susceptible  to 
the  poison  of  the  tubercle  bacillus. 

The  irritated  nerves  reflect  a  disgust 
for  food  or  give  rise  to  a  depraved  ap- 
petite. Abstention  from  food  or  use  of 
improper  food  starves  the  organs.  Badly 
nourished  organs  become  irritable  and  are 
upset  easily. 

The  vicious  circles  once  started,  go  on 
making  soil  for  the  tubercle  bacillus.  The 
growth  and  multiplication  of  the  tubercle 
bacillus  continue  to  stimulate  the  vicious 
circles.  The  end  is  destruction  of  the 
invaded  organism. 

The  first  thing  to  be  done  in  the  treat- 


2 1 6  Crusade  against  Tubermlosis 

ment  of  tuberculosis  is  to  break  into  these 
vicious  circles.  They  must  be  cut  into 
somewhere. 

The  presence  of  the  tubercle  bacillus 
is  the  beginning  of  the  vicious  circles. 
Could  we  kill  the  bacillus,  we  would  end 
the  matter ;   but  we  cannot. 

There  is  no  way  known  to  science  of 
attacking  the  bacillus  directly.  The  sub- 
stances which  are  known  to  kill  it  in  the 
laborator\^  also  kill  the  tissues.  We  can 
only  attack  it  indirectly. 

The  human  body,  however,  has  the 
power  of  manufacturing  its  own  germi- 
cides when  all  its  machineiy  is  in  good 
working  order  and  the  proper  material 
is  at  hand.  The  thing  to  do  then  is  to 
fix  up  the  damaged  machinery  and  to 
supply  the  required  material. 

Food  is  the  material  out  of  which  re- 
pair is  made  in  the  human  body.  It  is 
the  source  also  from  which  the  body 
draws   its  weapons    against  disease.      The 


Food  in  Consumption  217 

way  to  break  into  the  vicious  circles,  there- 
fore, is  to  force  into  the  system  a  large 
amount  of  easily  digested  food. 

The  food  must  be  suited  to  the  dam- 
aged machinery,  however,  because  repair 
must  be  made  through  that  machinery. 
Only  such  food  should  be  used  as  can  be 
transformed  easily  into  tissue. 

Enough  nutrition  must  be  provided  for 
the  body  to  meet  all  ordinary  demands 
and  at  the  same  time  the  extraordinary 
demands  of  disease-fighting  and  repair. 
Energy  also  must  be  laid  aside  for  emer- 
gencies from  intercurrent  diseases. 

Food  should  be  selected  with  a  view 
to  its  nutritive  value  and  its  digestibility. 
The  largest  amount  of  nutrition  with  the 
smallest  amount  of  labor  should  be  the 
rule  by  which  diet  is  regulated. 

It  is  not  so  much  a  question  of  how 
much  nutritive  value  is  in  a  food  as  how 
much  can  be  gotten  out  of  it  without 
fatigue  to    the    nutritive   system    and   irri- 


2i8         Crusade  against  Tuberculosis 

tation  to  the  lungs.  Sometimes  a  food 
with  low  nutritive  value  gives  better  re- 
sults than  one  with  high  nutritive  value, 
because  more  can  be  gotten  out  of  it  with- 
out injury. 

Milk  is  the  best  food  at  our  command 
in  the  treatment  of  consumption.  It  has 
a  relatively  low  nutritive  value  for  bulk, 
but  it  gives  an  excellent  return  for  the 
labor  involved  in  metamorphosis. 

It  should  be  used  as  new  and  fresh 
as  possible.  The  nearer  milking  time 
when  consumed,  the  less  the  labor  of 
changing  it  into  tissue. 

Milk  deteriorates  very  quickly  unless 
it  is  kept  clean  and  sterile.  It  is  a  good 
culture-medium  for  micro-organisms,  which 
make  it  indigestible  and  irritate  the  ali- 
mentary canal. 

Milk  should  always  be  kept  in  sterile  ves- 
sels. If  the  vessels  cannot  be  sterilized 
by  steam,  they  should  be  sterilized  by  dry 
heat  in  the  oven  or  on  top  of  the  stove. 


Food  in   Consumption  219 

Eggs  stand  next  to  milk  as  an  avail- 
able article  of  food  in  the  treatment  of 
consumption.  They  contain  a  higher  nu- 
tritive value  for  bulk  than  milk,  but  it 
costs  more  energy  to  extract  the  nutrition. 

Eggs  should  be  used  raw  if  the  patient 
can  take  them  so.  It  takes  less  energy 
to  digest  them  raw  than  cooked.  A  good 
way  of  taking  them  is  to  mix  them  with 
milk. 

Next  to  eggs  in  the  diet  of  a  consump- 
tive stands  meat.  There  is  more  nutritive 
value  in  meat  for  bulk  even  than  in  eggs. 
Meat  is  hard  to  change  into  tissue,  however. 

Meat  takes  a  long  time  to  digest.  For 
this  reason  the  most  easily  digested  meats 
should  be  selected  and  used  only  once  a 
day.  A  large  amount  may  be  taken.  It 
is  better  to  take  a  large  amount  once  a 
day  than  a  smaller  amount  more  frequently. 

Vegetables  and  fruit  should  be  used  in 
the  treatment  of  consumption  on  account 
of  the  minerals  and  acids  which  they  con- 


220  Crusade  against  Tuberculosis 

tain.  They  always  should  be  fresh  if  it  is 
possible  to  get  them  so. 

Nuts  are  a  valuable  article  of  food  in 
the  treatment  of  consumption.  They  are 
rich  in  nutritive  value.  Some  are  easily 
digested.  Almonds,  English  walnuts,  pe- 
cans, and  hickory -nuts  may  be  used. 

A  good  way  of  feeding  a  consumptive 
is  to  give  him  only  one  meal  of  solid 
food  a  day,  and  to  supplement  this  with 
milk,  eggs,  fruit,  and  nuts.  The  meal  may 
be  taken  in  the  middle  of  the  day  or 
in  the  evening. 

The  meal  should  consist  of  beefsteak, 
roast  beef,  or  roast  mutton,  fresh  vege- 
tables, fresh  fruit,  nuts,  and  if  desirable 
a  cup  of  coffee  or  a  little  wine.  It  should 
be  a  good  substantial  meal.  There  should 
be  no  pastry  and  no  dainties. 

In  addition  to  the  one  meal,  the  patient 
should  consume  not  less  than  three  quarts 
of  milk  and  six  raw  eggs  a  day.  The 
milk  and  eggs  may  be  taken  at  intervals  of 


Food  in  Consumption  221 

A  consumptive's  dietary  may  be  some- 
thing like  this :  A  pint  of  milk  before  get- 
ting out  of  bed  in  the  morning  ;  another 
pint  of  milk  and  two  raw  eggs  after  rising 
and  taking  a  bath  ;  and  a  pint  of  milk  and 
one  raw  ^g^  at  about  ten  o'clock  in  the 
forenoon. 

When  the  meal  is  taken  in  the  middle  of 
the  day,  a  pint  of  milk  may  be  taken  at 
three  o'clock  in  the  afternoon,  a  pint  of 
milk  and  two  raw  eggs  at  six  o'clock,  and 
a  pint  of  milk  and  one  raw  ^g'g  before 
retiring. 

When  the  meal  is  taken  in  the  evening,  a 
pint  of  milk  and  two  eggs  may  be  taken  at 
twelve  o'clock  instead  of  at  six.  Nuts  and 
fruit  may  be  used  at  any  time  of  the  day. 

If  the  patient  gets  very  hungry,  he  may 
have  cereals  in  the  morning  and  boiled  rice 
for  lunch  or  supper.  These  should  not  be 
allowed  unless  the  one  meal  be  eaten  and 
enjoyed. 

To  some  extent  the  diet  of  a  consump- 


22  2         Crusade  against  Tuberculosis 

tive  must  be  regulated  to  suit  his  idiosyn- 
crasies. Nothing  should  be  used  which 
gives  indigestion,  no  difference  how  valua- 
ble it  may  be  theoretically. 

A  practical  test  of  the  correctness  of  the 
diet  in  a  given  case  is  the  weight  record. 
If  the  diet  is  right  there  will  be  gain  in 
weight.  If  there  is  no  gain  in  weight,  the 
diet  probably  is  wrong. 

With  very  delicate  stomachs  the  food  has 
to  be  predigested  until  such  time  as  the 
stomach  can  take  it  in  its  natural  state. 
Gradually  the  stomach  acquires  greater 
capacity  for  food. 

With  tactful  perseverance  persons  who 
in  the  beginning  can  take  scarcely  any  food 
can  be  brought  to  take  from  three  to  four 
quarts  of  milk  and  from  six  to  twelve  raw 
eggs  a  day  and  a  good  square  meal  be- 
sides. Under  such  a  diet  they  rapidly 
regain  their  full  body-weight. 


CHAPTER  XXXVI 

Fresh  Air  in  the 
Treatment  of  Con- 
sumption 

IN  1 86 1  Dr.  Henry  McCdfcnac  read  a 
paper  before  the  Medical  and  Chirurgical 
Society  of  Belfast  on  the  fresh-air  treat- 
ment of  consumption.  He  was  hooted  at 
by  his  fellows  and  protests  were  entered 
against  the  reading  of  such  papers. 

It  took  a  long  time  for  the  idea  advo- 
cated by  Dr.  McCormac  to  percolate 
through  the  strong  prejudice  against  fresh 
air  which  had  grown  out  of  the  false  doc- 
trines about  the  cause  of  consumption.  As 
consumption  was  held  to  be  due  to 
draughts  and  colds,  it  was  hard  to  see 
how  fresh  air  could  have  any  other  than  a 
bad  effect. 

223 


2  24        Crusade  against  Ttiberculosis 

The  idea  was  not  lost,  however.  It  was 
taken  up  by  others,  and  it  was  put  to 
practical  test  by  Dr.  Brehmer,  himself  a 
consumptive.  Goerbersdorf  Sanatorium 
grew  out  of  it. 

Sanatoria  in  which  the  fresh-air  treat- 
ment was  used  sprang  up  in  all  parts  of  the 
world,  the  earliest  ones  all  branching  off 
from  Goerbersdorf  In  every  one  there 
was  a  practical  demonstration  that  fresh  air 
was  of  great  value  in  the  treatment  of  con- 
sumption. 

The  discovery  of  the  tubercle  bacillus 
and  its  associate  micro-organisms  as  the 
cause  of  consumption  also  helped  to  break 
down  the  old  prejudice  against  fresh  air. 
Draughts  and  colds  could  not  be  the 
cause  of  consumption  if  the  micro-organ- 
isms were. 

Knowledge  of  the  life-history  of  the 
tubercle  bacillus  as  it  accumulated  con- 
firmed the  good  opinion  in  which  fresh-air 
treatment  was  held.    The  germicidal  power 


Fresh  Air  in  Consu7nption  225 

of  sunlight  and  fresh  air  over  the  tubercle 
bacillus  in  itself  gave  sufficient  reason  for 
the  treatment. 

But  even  a  better  reason  was  found  in 
the  germicidal  powers  of  the  body,  which 
greatly  depend  upon  fresh  air.  The  germi- 
cidal powers  of  the  body  depend  on  nutri- 
tion ;  nutrition  depends  upon  metabolism, 
and  metabolism  depends  on  air  and  food. 

Oxygen  is  the  basis  of  all  physico-chem- 
ical action  in  the  body.  Practically  every 
function  is  more  or  less  dependent  upon  it. 

Food  could  not  be  transformed  into 
tissue  without  it ;  used  up  material  could 
not  be  carried  out  of  the  system  without  it  ; 
and  the  various  fluids  of  the  body  which 
are  necessary  for  different  functions  could 
not  be  made  without  it. 

Oxygen  as  consumed  by  the  body  for 
physico-chemical  purposes  is  supplied  prin- 
cipally by  the  air  which  is  breathed. 
Besides  carrying  in  oxygen,  the  respired 
air  moreover  carries  out  products  of  com- 

15 


2  26        Crusade  against  Tuberculosis 

bustion.  There  is  therefore  a  double 
reason  why  it  should  be  fresh  and  pure. 

How  important  air  is  to  the  human 
economy  may  be  gathered  from  the  short 
time  during  which  one  can  do  without  it. 
One  can  live  without  food  for  days,  and 
weeks,  but  without  air  for  a  few  moments 
only. 

The  rapidity  with  which  total  deprivation 
of  air  proves  fatal  to  the  living  body  also 
gives  us  some  idea  of  the  injury  which 
must  come  from  a  partial  deprivation  of  it 
for  a  long  time.  This  injury  likewise 
comes  when  the  air  is  of  bad  quality. 

Air  to  be  good  for  breathing  purposes 
should  be  fresh  outdoor  air — air  which 
has  not  been  breathed  before.  Rebreathed 
air  is  poisonous  to  the  human  organism. 

Air  rids  itself  of  impurities  very  quickly 
when  in  a  state  of  agitation,  but  retains 
them  for  a  long  time  when  quiet.  Outdoor 
air  is  therefore  good  and  indoor  air  is  bad. 

Air  which  is  shut  up  in  a  room  soon  be- 


Fresh  Air  in  Consumption  227 

comes  bad  when  breathed.  It  loses  its 
oxygen  and  is  loaded  with  products  of 
combustion  and  impurities  thrown  off  by 
the  body. 

Mixture  with  the  outside  air  and  agita- 
tion restores  it  and  makes  it  good  again.  It 
is  wonderful  what  powers  of  self-purifica- 
tion the  atmosphere  has. 

In  the  treatment  of  consumption  an 
ample  supply  of  good  fresh  outside  air, 
night  and  day,  without  intermission,  is 
necessary.  It  must  be  had  irrespective  of 
weather  and  temperature. 

Night  air  is  just  as  good  as  day  air,  and 
perhaps  a  little  better.  In  cities  at  least  it 
is  freer  from  dust  and  smoke  than  day  air. 

When  possible,  consumptives  should 
sleep  outdoors  at  night.  If  they  cannot 
sleep  outdoors  they  should  make  indoors 
as  near  like  outdoors  as  possible. 

Every  window  in  the  bedroom  should  be 
kept  open.  Blinds  and  shades  should  be 
taken  down  and  shutters  should  be  taken 


228         Crusade  against  Tuberculosis 

off  or  thrown  open.  Sun  and  air  should  be 
allowed  free  access  to  the  room. 

There  need  be  no  fear  of  draughts. 
Without  draughts  the  air  in  a  room  cannot 
be  kept  fresh  and  pure.  Draughts  can  do 
no  injury  when  a  person  is  properly  pro- 
tected by  clothing  or  bed-clothes. 

Outside  air  is  good  anywhere.  Even  in 
cities  outside  air  answers  all  practical  pur- 
poses for  the  cure  of  consumption.  Coun- 
try air,  of  course,  is  freer  from  smoke  and 
dust  and  is  fresher  and  sweeter  than  city 
air ;  but  city  air,  if  it  is  outside  air,  is  good 
enough. 

Mountain  air  is  believed  to  have  special 
qualities  of  value  in  the  treatment  of  con- 
sumption. These  probably  are  more 
imaginary  than  real.  It  may  be  that  moun- 
tain air,  in  certain  cases,  helps  to  bring 
about  recovery  by  expanding  the  lungs 
more  than  usual. 

Sea  air  sometimes  is  of  value  in  the 
treatment  of  consumption,  when  the  disease 


Fresh  Air  in  Consumption  229 

is  complicated  with  heart  trouble.  Such 
cases  do  much  better  at  sea-level  than  in 
the  mountains. 

Climate  in  itself  is  of  little  value  in  the 
treatment  of  consumption.  It  is  the  out- 
side air  which  counts,  and  it  makes  very 
little  difference  where  this  outside  air  is 
gotten  from,  so  it  is  gotten  every  day  and 
all  the  day  and  night. 


CHAPTER  XXXVII 

Rest  and  Exercise 

in  the  Treatment  of 

Consumption 

THE  false  notion  that  consumption  is  in 
some  way  connected  with  inactivity  has 
led  to  wrong  conceptions  about  treat- 
ment of  the  disease  which  are  shared  by 
the  medical  profession  and  the  laity  alike. 
Exercise  as  part  of  the  treatment  is  in- 
sisted on  under  any  and  all  circumstances. 

Frequently  poor  consumptives  exercise 
themselves  into  the  grave.  The  worst 
of  it  is  that  they  do  it  under  advice  from 
the  doctor  and  for  the  purpose  of  re- 
covery. 

Keep  out  in  the  open  air  is  the  order 
usually  given.  Unfortunately  this  is  in- 
terpreted to  mean,  and  perhaps  is  meant 

230 


Rest  and  Exercise  231 

so  by  the  doctor,  keep  moving  in  the 
open  air,  either  walking-,  riding,  or  driving. 
Among  the  poor  it  means  keep  working. 

Exercise  under  certain  circumstances 
and  conditions  is  very  prejudicial  to  con- 
sumptives. It  often  is  the  stumbling-block 
in  the  way  of  recovery.  All  the  rest  of 
the  treatment  may  be  good,  but  this  one 
error  counteracts  all  the  good  that  is  done. 

If  a  consumptive  is  much  below  weight, 
he  ought  to  be  allowed  to  accumulate 
some  energy  before  using  up  what  he 
makes.  His  nutritive  system  may  not 
be  able  to  supply  all  the  demands  of  the 
body  and  accumulate  energy  at  the  same 
time. 

Fever  is  a  great  consumer  of  energy. 
When  a  consumptive  has  fever,  he  is  apt 
to  lose  weight  rapidly  unless  he  keeps 
quiet.  His  fever  may  be  increased,  too, 
by  exercise. 

When  the  circulation  is  embarrassed  by 
the  heart  pumping  up  against  an  obstruc- 


232  Crusade  against  Tiiberciilosis 

tion,  the  embarrassment  is  greatly  aug- 
mented by  exercise.  A  pulse  which  already 
is  much  too  rapid  increases  in  rapidit}^ 

Not  onlv  is  the  heart  thus  weakened 
and  the  nutrition  of  the  entire  body 
thereby  interfered  with,  but  the  diseased 
tissue  becomes  congested  and  the  growth 
of  the  micro-organisms  is  stimulated. 
Fatigue  of  the  body  is  a  fertilizer  to  the 
micro-organisms. 

A  single  severe  fatigue  during  the  active 
stage  of  tuberculosis  may  be  the  turning- 
point  from  the  road  to  recovery  to  the 
road  to  death.  Many  a  consumptive  has 
returned  from  a  long  w^alk  or  drive  upon 
which  he  had  entered  as  a  good  case  with 
the  death-mark  upon  him. 

Sometimes  a  complication  of  pneumonia 
sets  in  after  severe  fatigue,  which  leaves 
the  patient  a  physical  wreck.  Even  if 
he  picks  up  again,  he  will  have  lost  much 
time. 

For  the  consumptive  in  the  active  stage 


Rest  and  Exercise  233 

of  the  disease  absolute  rest  in  the  open 
air  is  necessary.  This  may  be  taken  in 
bed  or  on  a  steamer-chair. 

The  temperature  and  the  pulse-rate  are 
the  guide  for  how  long  this  rest  should  be 
kept  up.  So  long  as  the  temperature  goes 
up  to  101°  F.  and  above,  and  the  pulse- 
rate  up  to  1 20  and  over,  there  should  be 
absolute  rest. 

As  the  temperature  and  the  pulse-rate 
come  down  and  body-weight  increases,  rest 
gradually  should  give  way  to  exercise. 
At  first  the  exercise  should  be  passive, 
then  active.  Massage,  carriage -driving, 
horseback-riding,  walking,  and  severe 
physical  exertion,  in  the  order  named,  is 
the  exercise  which  may  be  taken  up.  It 
ahvays  should  remain  within  the  bounds 
of  fatigue. 

Deep  breathing  is  a  form  of  exercise 
which  may  be  begun  relatively  soon  after 
acute  symptoms  have  passed  off.  It 
always  should    be    used    when    there    are 


2  34  Crusade  against  Tuberculosis 

no  acute  symptoms.  It  not  only  improves 
the  muscles  of  the  chest,  but  it  helps  the 
circulation  and  benefits  nutrition. 

Whatever  form  of  exercise  is  adopted  it 
should  be  added  to  daily  in  the  same  pro- 
portion and  in  small  quantities.  Five  to 
ten  minutes  a  day  may  be  added  accord- 
ing to  the  strength  of  the  individual  and 
the  effect  which  exercise  has  on  him. 

As  the  patient  grows  in  strength  ex- 
ercise really  becomes  an  important  factor 
in  the  cure.  The  heart  action  improves 
with  exercise,  and  metabolism  is  benefited. 
Toward  the  end  of  the  treatment  the  pa- 
tient ought  to  do  eight  hours  work  a 
day. 


CHAPTER  XXXVIII 

How   Long  it 
Takes  for  Consump- 
tion to  Get  Well 

IN  acute  diseases  the  struggle  between  the 
invaded  organism  and  the  disease  germ  is 
intense  but  brief.  Either  the  organism 
goes  under  or  the  disease  germ  is  ejected, 
leaving  behind  immunity  of  shorter  or 
longer  duration. 

In  chronic  diseases  time  and  not  inten- 
sity is  the  dominant  factor.  The  struggle 
between  the  organism  and  the  disease 
germ  may  endure  a  very  long  while  with- 
out victory  for  either  side. 

From  the  very  nature  of  things  con- 
sumption must  be  long  in  getting  well. 
The  tubercle  bacillus  once  in  the  system, 
grows  and  reproduces  itself  so  long  as  it 
has  soil,  unless  destroyed  or  thrown  out. 

235 


236  Crusade  against  Tuberculosis 

Soil  is  not  easily  worn  out  because  the 
disease  is  local  and  is  slow  in  growth. 
Immunity  is  long  in  coming,  and  when  it 
comes,  often  is  of  little  use.  Too  much 
tissue  has  been  destroyed  to  make  re- 
covery any  longer  possible. 

Destruction  of  the  tubercle  bacillus  by 
the  disease-fighters  of  the  blood  can  go  on 
only  so  long  as  the  invaded  tissue  has  not 
been  cut  off  from  the  circulation.  This  is 
recovery  b}'  phagocytosis  and  absorption. 
It  is  a  slow  process. 

When  the  tubercles  have  been  cut  off 
from  the  circulation,  softening  takes  place 
in  them.  An  opening  forms  from  the 
softened  nodules  to  the  nearest  surface  in 
contact  with  the  air,  and  the  broken-down 
matter  is  thrown  out.  The  injured  part 
then  heals  up  and  forms  a  scar.  This 
process  is  much  slower  than  the  first. 

When  a  very  large  amount  of  tissue 
close  together  is  invaded,  it  all  may  break 
down  at  one  time  in  the  form  of   an  ab- 


Time  of  Recovery  237 

scess  and  leave  a  large  hole  or  cavity. 
The  cavity  becomes  a  culture-field  for  the 
tubercle  bacillus. 

For  a  cavity  of  this  kind  to  heal  up 
nature  first  must  sterilize  it  and  then  con- 
tract it  so  as  to  bring  its  walls  close  to- 
gether. When  the  cavity  is  in  the  lungs, 
the  whole  chest  has  to  accommodate  itself 
to  the  new  condition  of  things.  This  is 
the  slowest  process  of  all. 

Occasionally  nature  heals  up  a  diseased 
organ  by  what  is  called  fibrosis  or  harden- 
ing. The  tissues  are  gradually  changed 
into  a  condition  in  which  they  no  longer 
can  give  sustenance  to  the  micro-organ- 
isms. The  process  is  exceedingly  slow, 
and  when  complete  may  leave  the  organ 
so  crippled  as  to  make  it  almost  useless. 

Recovery  by  what  is  called  encapsula- 
tion sometimes  takes  place.  By  this  pro- 
cess the  nodule  is  encased  in  a  coating  of 
lime  and  is  thus  entombed  in  the  tissues, 
to  remain  there.     Sometimes   later  in  life 


238  Crusade  against  Tuberculosis 

nature  attacks  the  nodule,  dissolves  it,  and 
throws  it  out,  at  the  same  time  reintroduc- 
ing the  bacillus  into  the  system.  This  pro- 
cess also  is  slow. 

A  consumptive  may  get  well  physically, 
without  getting  well  scientifically.  He 
may  regain  full  strength  and  vigor  and 
present  the  appearance  of  perfect  health 
without  being  free  from  tubercle  bacilli. 

In  this  condition  he  is  like  an  extinct 
volcano  which  may  break  out  again.  He 
has  within  him  millions  of  tubercle  bacilli 
which  for  the  time  being  are  harmless  be- 
cause they  are  locked  up.  If  he  maintains 
a  high  standard  of  health,  he  may  go 
through  life  without  their  being  set  free. 

Recovery  is  slow  in  tuberculosis  even 
when  the  disease  is  in  its  beginning.  It 
takes  from  three  to  six  months  under  the 
most  favorable  circumstances.  Even  then 
there  is  uncertainty  of  the  recovery  being 
complete. 

When  the  disease   has  advanced  to  the 


Time  of  Recovery  239 

stage  of  softening,  a  much  longer  period  is 
required  for  recovery.  The  process  is  a 
more  complicated  one  and  extensions  are 
more  apt  to  occur. 

The  time  required  for  recovery  also  in- 
creases in  proportion  to  the  amount  of  tis- 
sue involved  and  the  number  of  org-ans 
affected.  The  more  tissue  involved  and  the 
larger  the  number  of  organs  involved,  the 
longer  it  takes  for  recovery  to  take  place, 
until  a  point  is  reached  where  recovery  is 
impossible. 

When  softening  has  taken  place  with  only 
a  small  amount  of  tissue  involved,  it  takes 
from  one  year  to  eighteen  months  for  com- 
plete recovery.  When  there  is  softening 
with  a  large  amount  of  tissue  involved,  it 
takes  from  two  to  three  years  for  recovery, 
and  even  then  the  recovery  may  not  be  com- 
plete. 

When  large  cavities  have  formed,  com- 
plete recovery  seldom  takes  place,  although 
good  health  may  be  attained.     When  com- 


240  Crusade  against  Tuberculosis 

plete  recovery  does  take  place  in  these 
cases,  it  is  a  matter  of  many  years. 

In  the  slowness  of  tuberculosis  lies  its 
venom.  It  would  not  be  nearly  so  fatal 
were  it  not  so  slow.  Its  victims  become 
impatient  and  do  things  which  lead  to  their 
own  destruction  because  of  their  impatience. 

It  is  natural  for  a  person  to  think  he  is 
well  when  he  feels  well.  A  consumptive 
soon  improves  under  treatment.  He  begins 
to  feel  well  and  look  well.  Everybody  says 
he  looks  well. 

Gradually  the  physician's  advice  loses 
weight.  His  counsel  is  disregarded.  After 
all,  may  not  the  doctor  be  mistaken?  Feel- 
ing begins  to  govern  the  patient's  conduct 
rather  than  reason. 

A  little  relaxation  in  the  rigorous  life  at 
first.  A  little  more  later,  because  no  per- 
ceptible injury  has  come  from  the  first.  In- 
sidiously the  disease  goes  on,  while  the 
patient  is  lulled  into  a  feeling  of  security. 

Suddenly  an  intercurrent  disease  inter- 


Time  of  Recovery  241 

venes.  There  is  a  bad  spell  for  a  while. 
When  the  storm  has  subsided,  the  progress 
which  has  been  make  by  the  tuberculosis 
is  quite  patent. 

Again  the  physician's  counsel  is  sought 
and  his  advice  accepted.  Again  the  rigor- 
ous life  is  begun.  Again  improvement  sets 
in.  Again  come  doubt  and  relaxation. 
And  again  another  intercurrent  disease  to 
mark  another  milestone  in  the  progress  of 
the  consumption. 

Many  a  life  has  been  sacrificed  to  vacilla- 
tion in  the  treatment  of  tuberculosis.  It  is 
all  because  recovery  is  so  slow.  The  poor 
victim  cannot  keep  up  his  courage  to  go 
through  with  it  all. 

A  person  who  has  tuberculosis  should 
start  on  his  treatment  with  his  mind  pre- 
pared for  a  long  siege.  He  should  say  to 
himself,  "  It  will  take  years  to  save  my  life, 
but  my  life  is  worth  the  struggle." 

No  difference  how  well  he  gets  and  how 
well  he  feels,  he  should  not  consider  him- 


16 


242         Crusade  against  Tuberculosis 

self  secure  under  eight  or  ten  years '  test  of 
his  cure.  He  should  live  a  careful  method- 
ical life  during  that  time  and  avoid  every- 
thing which  exhausts  the  nervous  system 
or  severely  taxes  his  physical  endurance. 


CHAPTER  XXXIX 

The  Prevention 

of  the  Spread  of  Tu- 
berculosis 

A  CONSOLING  corollary  of  the  conta- 
giousness of  tuberculosis  is  the  preventa- 
bility  of  the  disease.  What  is  due  to  life 
can  be  destroyed  and  exterminated. 

Inasmuch  as  every  new  case  of  tubercu- 
losis must  be  propagated  from  an  old  one, 
it  is  possible,  theoretically  at  least,  to  stop 
the  propagation  by  shutting  off  the  seed- 
supply.  It  is  true  practically  this  may  be 
a  little  difficult  of  execution. 

When  one  considers  the  widespread  ex- 
istence of  tuberculosis  throughout  the 
animal  kingdom  and  the  many  factors 
which  enter  into  its  spread,  it  does  look 
like  a  hopeless  task  to  try  to  stamp  it  out. 
At  one  fell  stroke  it  cannot  be  done. 

243 


244         Crusade  against  Tuberculosis 

In  division  of  the  task,  however,  lies  the 
hope  of  success.  One  case  can  be  pre- 
vented at  a  time.  Every  case  prevented 
means  one  case  less  from  which  seed  can 
come.     The  task  gradually  grows  smaller. 

Even  in  practice  the  task  is  not  quite 
so  difficult  as  it  looks.  Nature  herself 
does  much  to  prevent  the  spread  of  the  dis- 
ease. 

The  enemies  of  the  tubercle  bacillus  are 
everywhere.  Outdoors  the  bacillus  can 
scarcely  live.  Sunshine,  fresh  air,  and  rain 
destroy  it.  Constantly  the  disintegrating 
forces  of  nature  are  at  work. 

The  tubercle  bacillus  has  a  twofold  exist- 
ence— that  within  a  host,  which  is  active, 
and  that  without  a  host,  which  is  passive. 
The  active  life  is  the  parasitic  life ;  the 
passive  Hfe  is  the  dormant  or  granary  life. 

Outside  of  a  host  the  tubercle  bacillus 
must  have  the  protection  of  broken-down 
tissue  for  maintenance  of  its  viability.  If 
the  broken-down  tissue  becomes  too  much 


Prevention  of  Tuberculosis  245 

disintegrated  and  the  bacillus  gets  shelled 
out  of  the  hull,  so  to  speak,  it  dies. 

The  matter  in  which  the  tubercle  bacillus 
is  cached  is  gross  at  the  time  when  it  is 
given  off.  It  easily  can  be  seen  and 
handled.  When  it  becomes  so  finely  pul- 
verized as  to  be  invisible,  it  soon  becomes 
sterile. 

For  the  prevention  of  the  spread  of 
tuberculosis  it  is  necessary  to  deal  only 
with  the  passive  or  granary  existence  of  the 
tubercle  bacillus. 

The  prevention  of  the  spread  of  tuber- 
culosis therefore  resolves  itself  into  steriliz- 
ing all  tubercular  matter  as  soon  as  it  is 
given  off.  Could  this  be  done,  the  disease 
would  soon  become  extinct. 

Unfortunately  it  cannot  be  done  at  pres- 
ent. There  are  too  many  consumptives  who 
are  ignorant  of  the  contagious  nature  of 
the  disease  from  which  they  suffer. 

Even  those  who  do  know  that  the 
disease  is  contagious  do  not  know  how  to 


246         Crusade  against  Tuberculosis 

sterilize  broken-down  matter.  Very  few,  in 
fact,  know  that  the  contagion  resides  in 
this  matter. 

The  first  step  necessary  in  the  prevention 
of  tuberculosis  is  to  educate  the  people. 
This  must  be  done  by  practical  demonstra- 
tion, however,  and  not  by  teaching  and 
preaching. 

To  tell  people  that  they  must  steril- 
ize all  broken-down  tissue  is  one  thing ;  to 
show  them  how  to  do  it  is  another.  Very 
few,  even  among  intelligent  people,  learn 
how  to  do  a  thing  right  from  merely  being 
told  how  to  do  it. 

The  poor  people,  above  all,  need  to  be 
shown  what  to  do  and  how  to  do  it.  In 
fact,  they  even  should  be  supplied  with  the 
things  necessary  to  do  it  with. 

Well  may  governments  and  philanthro- 
pists vie  with  each  other  in  bringing  this 
knowledge  to  the  poor  in  a  practical  way. 
Governments  can  act  through  Boards  of 


Prevention  of  Tuberculosis  247 

Health  and  philanthropists  through  dispen- 
saries, hospitals,  and  sanatoria. 

That  the  spread  of  tuberculosis  can  be 
prevented  by  proper  measures  has  been 
amply  demonstrated.  Wherever  anything 
has  been  done  to  prevent  the  spread  of  the 
disease  results  have  been  obtained. 

In  the  eighteenth  century  the  kingdom 
of  Naples,  which  comprised  the  southern 
half  of  Italy  and  Sicily,  was  plague- 
stricken  with  consumption.  So  malignant 
was  the  disease  that  even  the  people  recog- 
nized its  contagious  nature. 

In  1782  stringent  laws  were  passed  in 
the  kingdom  for  the  restriction  of  the 
disease.  Every  case  of  consumption  was 
registered  and  quarantined,  and  places  and 
things  which  had  been  contaminated  by 
consumptives  were  sterilized. 

In  fifty  years  the  death-rate  from  con- 
sumption in  the  kingdom  diminished  so 
greatly  that  the  law  was  allowed  to  fall 
into  desuetude.     The  doctrine  of  the  con- 


248  Crusade  against  Tuberculosis 

tagiousness  of  tuberculosis  even  was  lost 
to  the  medical  profession. 

England  began  to  open  hospitals  for 
consumptives  in  the  early  part  of  the  nine- 
teenth century.  At  that  time  London  and 
Paris  had  exactly  the  same  death-rate  from 
consumption. 

England  added  to  its  beds  for  consump- 
tives right  along.  Most  of  the  beds  were 
placed  in  London.  Paris  established  no 
beds  for  consumptives. 

In  fifty  years  London's  death-rate  from 
consumption  went  down  two-thirds.  The 
death-rate  from  the  disease  in  Paris  re- 
mained the  same  until  quite  recently. 

In  Philadelphia  and  New  York  the 
death-rate  from  consumption  has  been 
reduced  one-third  in  about  fifteen  years 
by  modem  preventive  measures.  In  these 
measures  there  has  been  no  hardship  to 
any  one. 

With  our  present  exact  knowledge  of 
tuberculosis    preventive    measures    can    be 


Prevention  and  Tuberculosis  249 

carried  out  along  humane  lines.  There 
need  be  no  quarantine  and  no  hardships. 
The  people  must  be  educated,  however, 
to  a  better  knowledge  of  the  subject. 
Knowledge  will  take  away  fear  and  bring 
hope.  It  also  will  induce  governments 
and  philanthropists  to  supply  the  means 
with  which  to  inaugurate  preventive  meas- , 
ures. 


CHAPTER  XL 

The  Consumptive  can 

Avoid  Giving  His  Disease 

to  Others 

CONSUMPTION  slowly  poisons  the  ner- 
vous system  and  brings  about  changes  in  it 
which  more  or  less  transform  the  character 
of  the  person  who  has  the  disease. 

The  consumptive  •  becomes  irritable,  self- 
ish, suspicious,  and  sometimes  indifferent 
about  ethics.  Often,  indeed,  his  condition 
borders  on  insanity. 

This  altered  state  comes  on  very  slowly 
and  insidiously.     It    becomes    more    pro- 
nounced in  proportion  to  the  duration  of 
the    disease.     Always    the    most    striking 
feature  is  selfishness. 

To  protect  others  often  is  a  matter  of  in- 
difference to  the  consumptive.  It  is  incon- 
venient to  do  so,  and  he  prefers  to  do  that 

250 


Protection  of  Others  251 

which  is  convenient.  Preventive  measures 
attract  attention  to  his  disease  and  he  doesn't 
want  to  attract  attention  to  it. 

But  fortunately  an  incentive  to  protect 
others  always  can  be  found  for  the  con- 
sumptive in  his  own  selfishness.  His  own 
recovery  depends  upon  observance  of  those 
rules  of  hygiene  which  are  necessary  for 
the  protection  of  others. 

This  incentive  always  can  be  held  out 
to  him  truthfully.  The  rules  of  hygiene 
which  are  necessary  for  the  protection  of 
others  are  still  more  necessary  for  himself 
because  he  is  nearest  to  himself. 

Recovery  from  tuberculosis  depends 
largely  upon  prevention  of  new  implanta- 
tions. Nature  gets  rid  of  the  old  growth, 
but  new  ones  come  up  all  the  time.  The 
consumptive  himself  has  much  to  do  with 
this. 

As  he  himself  is  the  source  of  seed-sup- 
ply and  the  center  of  distribution,  he  neces- 
sarily lives  in  an  atmosphere  of  contamina- 


252  Q'tisade  against  Ttiberculosis 

tion  unless  he  sterilizes  all  tubercular  matter 
the  moment  it  is  given  off.  If  he  does  not 
make  himself  and  everything  about  him 
sterile,  he  cannot  fail  to  sow  new  crops. 

When  he  spits  into  a  handkerchief  he 
necessarily  inhales  the  dried  sputum  which 
already  is  in  the  handkerchief,  for  he  has 
to  take  a  deep  breath  before  spitting,  and 
he  takes  this  breath  with  the  handkerchief 
before  his  mouth.  He  soils  his  fingers  and 
lips  and  mustache,  if  he  has  one,  and  then 
mixes  tubercular  matter  with  his  food. 

When  he  puts  a  soiled  handkerchief  in 
his  pocket  he  contaminates  his  clothing, 
and  wherever  he  goes  thereafter  the  slight- 
est agitation  of  his  clothing  raises  a  con- 
taminated atmosphere  about  him  which 
he  must  inhale.  When  he  spits  recklessly 
about  his  room  he  has  to  inhale  tubercle- 
laden  dust  every  time  he  is  in  it. 

Indeed,  whenever  he  offends  against  the 
laws  of  hygiene,  he  by  that  much  lessens 
his   chances    of   recovery.       He  always  is 


Protection  of  Others  253 


nearest  to  himself,  and  necessarily  always 
will  suffer  most  from  his  own  neglect. 

He  in  reality  has  a  double  incentive  to 
make  himself  sterile ;  his  own  recovery 
first,  and  the  protection  of  others  next. 
He  has  it  in  his  power  to  make  himself 
absolutely  sterile  at  all   times. 

The  entire  code  of  hygiene  in  tubercu- 
losis can  be  summed  up  in  one  word — 
cleanliness.  The  consumptive  who  is  im- 
maculately clean  cannot  reimplant  the  dis- 
ease in  himself  nor  convey  it  to  others. 

To  be  clean  in  tuberculosis,  however, 
means  to  dispose  of  every  particle  of  tu- 
bercular matter  the  moment  it  is  given  off, 
and  to  dispose  of  it  in  such  a  way  as  to 
make  soiUng  of  hands,  mouth,  clothing, 
bedding,  furniture,  and  place  impossible. 
The  matter  must  be  deposited  either 
where  it  can  be  sterilized  at  once  or  de- 
stroyed before  it  can  come  in  contact  with 
anything  else. 

Tubercular  sputum  should  be  deposited 


254        Crusade  agamst  Tuberculosis 

in  a  cup  with  a  handle.  The  cup  should 
have  a  handle  in  order  that  it  may  be 
held  close  to  the   mouth. 

There  are  many  kinds  of  cups  in  the 
market,  to  be  had  in  drug-stores,  which 
may  be  used.  One  of  the  best  is  a  tin  cup 
with  a  paper  cup  inside.  With  this  the 
sputum  is  deposited  in  the  paper  cup  and 
the  paper  cup  is  then  burned.  The  tin  cup 
is  boiled  daily. 

For  the  poor,  an  ordinary  china  coffee- 
cup  \vith  a  handle  is  perhaps  the  cheapest 
and  best.  Lye  which  is  used  for  scrubbing 
and  soap-making  and  a  little  water  should 
be  put  in  the  cup,  and  the  cup  should  be 
emptied  and  scalded  twice  or  three  times  a 
day. 

A  consumptive  should  never  use  a  hand- 
kerchief or  rag  to  spit  in.  He  not  even 
should  use  such  things  to  wipe  his  mouth 
with. 

When  he  cannot  spit  into  his  cup  he 
should  spit  into  a  paper  napkin,  fold  up  the 


Protection  of  Others  255 

napkin  carefully,  and  place  it  in  a  paper 
bag.  He  always  should  use  a  paper  nap- 
kin to  wipe  his  mouth  with,  and  when  he 
has  used  the  napkin  he  should  place  it  in 
the  bag.  This  bag  he  should  burn  when 
he  has  an  accumulation  of  napkins. 

There  are  in  the  market,  to  be  had  at 
drug-stores,  sputum  flasks  and  heavy  paper 
receptacles  which  can  be  carried  in  the 
pocket.  Any  one  of  these  may  be  used, 
but  they  are  all  much  more  costly  than 
paper  napkins  and  paper  bags. 

Men  can  always  cany  paper  bags  and 
napkins  in  their  coat  pockets.  Women  can 
carry  them  in  a  caba.  Paper  napkins  and 
bags  are  inexpensive  and  do  not  attract 
much  attention. 

A  consumptive  should  be  very  careful 
not  to  let  any  spit  get  on  his  clothing,  on 
bedding,  or  on  the  floor.  He  always  should 
take  pains  not  to  soil  his  hands  and  lips, 
and  in  order  to  be  doubly  sure  he  should 
wash  these  frequently. 


256        Crusade  against  Tuberculosis 

If  by  any  chance  a  particle  of  spit  should 
be  deposited  anywhere  else  than  in  the  spit 
cup  or  in  a  paper  napkin,  it  should  be  taken 
up  at  once  or  sterilized  where  it  is. 

For  sterilizing  spit  which  has  been  de- 
posited where  it  should  not  have  been,  lye 
and  water,  carbolic  acid,  or  formalin  may 
be  used.  The  best  way  is  to  take  up  the 
spit  and  destroy  it. 

Consumptives  with  running  sores  should 
carefully  take  up  all  discharges  on  absorb- 
ent cotton  and  burn  them.  Pains  should 
be  taken  not  to  permit  the  discharges  to 
dry  and  be  scattered  about,  or  to  soil 
clothing.  The  skin  about  running  sores 
frequently  should  be  washed. 

Consumptives  should  not  shake  hands 
nor  kiss  on  the  mouth.  These  customs 
are  dangerous  to  the  well  and  to  themselves. 
They  are  dangerous  to  the  well  because 
they  may  give  them  consumption  ;  they  are 
dangerous  to  themselves  because  they  may 
give  them  colds  and  influenza. 


Protection  of  Others  257 

A  consumptive  should  never  spit  any- 
where except  into  his  spit  cup  or  paper 
napkin.  Then  he  is  sure  that  he  controls 
the  contagion  which  he  gives  off. 

When  he  has  spat  he  should  carefully 
wipe  his  mouth  with  a  paper  napkin.  He 
soon  learns  to  do  all  these  things  without 
soiling  his  hands  or  lips.  When  he  has 
learned  to  do  them  he  can  console  himself 
with  the  idea  that  he  is  harmless. 

Consumptive  men  with  mustaches  and 
beards  should  shave  them  off.  It  is  prac- 
tically impossible  for  a  man  with  a  mustache 
and  whiskers  to  avoid  contaminating  them 
in  spitting. 

Consumptives  should  have  their  own 
eating  and  drinking  utensils.  At  least  they 
should  see  that  eating  and  drinking  utensils 
which  they  have  used  are  washed  before 
being  used  by  others. 

For  this  last  troublesome  precaution  the 
consumptive  gets  nothing  in  return  except 
the  consciousness  that  he  is  doing  his  duty 

17 


258  Crusade  against  Tuberculosis 

to  his  neighbor  For  all  the  others  he  has 
the  return  of  protecting  himself  against  ex- 
tension of  his  disease. 

Surely  it  is  worth  a  sacrifice  to  prevent 
another  from  getting  so  loathsome  a  dis- 
ease. The  more  so  because  the  protection 
is  most  apt  to  come  to  some  one  who  is 
very  near  and  dear. 


CHAPTER  XLI 

The  Government  in  the 
Prevention  of  Tuber- 
culosis 

IN  THE  organization  of  society  man  has 
handed  over  many  of  his  personal  rights 
to  government.  In  matters  of  Hfe  he  has 
retained  only  the  right  of  self-defense 
against  direct  personal  attack. 

Against  dangers  from  accident  and  dis- 
ease he  has  handed  over  his  right  of  inter- 
ference with  the  conduct  of  others  to  the 
government,  which  agrees  to  protect  him 
by  regulation  of  the  conduct  of  all.  This 
the  government  does  in  return  for  the  liber- 
ties which  he  gives  up. 

Governments  have  been  ready  enough  to 
protect  individuals  against  accidents,  and 
have  passed  all  kinds  of  laws  for  this  pur- 
pose.    They  have  been  slow,  however,  in 

259 


26o         Crusade  against  Tuberculosis 

making  laws  for  the  protection  of  the  indi- 
vidual against  disease. 

This  no  doubt  has  been  due,  in  part  at 
least,  to  ignorance  of  the  cause  of  disease. 
In  knowledge  the  government  is  the  people. 
Until  relatively  recently  the  people  have 
looked  upon  disease  as  a  providential  visita- 
tion. 

As  knowledge  of  the  real  cause  of  dis- 
ease comes  to  the  people  efforts  begin  to  be 
made  to  prevent  disease.  Expressed  in  law, 
these  efforts  are  patchwork,  because  the 
knowledge  comes  piecemeal. 

In  most  countries  governments  have 
begun  their  efforts  at  prevention  of  disease 
by  creating  Boards  of  Health.  Meagerness 
of  knowledge  probably  made  them  do  this. 
They  gave  the  Boards  arbitrary  powers, 
because  there  was  not  enough  knowledge 
upon  the  subject  for  definite  laws. 

Gradually  Boards  of  Health  are  evoluting 
into  regular  departments  of  government 
with  clearly  defined  powers.     Definite  laws 


Governments  in  Prevention  261 

also  are  being  enacted  for  the  guidance 
of  such  departments. 

One  of  the  impediments  to  progress  in 
the  evolution  of  health  departments  has 
been  the  reluctance  of  people  to  spend 
money  for  the  prevention  of  disease.  The 
people  have  not  yet  learned  the  economical 
value  of  health. 

For  this  reason  governments  have  done 
little  for  the  prevention  of  tuberculosis. 
Boards  of  Health  perhaps  have  not  done  as 
much  as  they  should  have  done  to  engraft 
new  knowledge  upon  law. 

In  very  few  places  indeed  has  the  gov- 
ernment as  yet  given  official  indorsement  to 
the  contagiousness  of  tuberculosis.  Where 
it  has  done  so,  it  has  done  little  else. 

Gradually,  however,  the  people  are  be- 
coming educated  to  a  full  sense  of  apprecia- 
tion of  what  prevention  of  a  disease  like 
tuberculosis  means.  With  this  education 
will  come  governmental  action. 

As   governments   now  are  equipped  for 


262  Crusade  against  Tuberculosis 

prevention  of  disease,  in  most  places,  it 
would  be  difficult  to  carry  out  a  compre- 
hensive scheme  for  the  prevention  of  tuber- 
culosis. There  are  many  things,  however, 
which  Boards  of  Health  could  do. 

The  first  thing  which  Boards  of  Health 
should  do  is  to  register  all  cases  of  tuber- 
culosis. This  would  give  knowledge  of 
where  the  danger  is  which  is  to  be  met. 
Without  this  knowledge  all  effort  is  handi- 
capped. 

Some  men  object  to  registration  on  the 
score  of  hardship  and  publicity.  There  is 
no  hardship,  because  quarantine  is  unneces- 
sary.    There  need  be  no  publicity. 

Prevention  of  tuberculosis  does  not  follow 
along  the  lines  laid  down  in  the  past  for  the 
prevention  of  other  diseases.  To  be  effective, 
it  must  be  along  lines  of  humanity. 

The  poor  consumptive  must  be  looked  up 
for  the  purpose  of  extending  him  aid  and 
not  of  persecuting  him.      He  can  make  him- 


Governments  in  Prevention  263 

self  harmless  to  others  if  shown  how  and 
supplied  with  the  means  of  doing  it. 

Registration  would  not  give  any  publicity 
which  the  disease  itself  does  not  give. 
Consumption  cannot  be  hidden.  Its  symp- 
toms are  too  pronounced  and  too  well 
recognized  for  that. 

Government  supervision  of  consumptives 
would  lessen  their  hardships  by  inspiring 
public  confidence.  The  public  would  fear 
the  consumptive  less  if  it  were  certain  that 
he  is  taking  the  proper  precautions  against 
spreading  the  disease. 

Boards  of  Health  should  instruct  con- 
sumptives and  the  members  of  their  fam- 
ilies in  what  is  to  be  done  for  the  preven- 
tion of  the  spread  of  the  disease.  With 
the  educated  and  well-to-do  this  might  be 
done  by  tracts  ;  with  the  ignorant  and  poor 
by  word  of  mouth  through  an  agent. 

Boards  of  Health  should  guarantee  pro- 
tection to  fellow-employees  of  consump- 
tives.   A  consumptive  employee  should  not 


264         Crusade  against  Tuberculosis 

be  permitted  to  continue  his  employment 
unless  he  takes  the  proper  precautions  for 
the  protection  of  others. 

Fellow-employees  cannot  protect  them- 
selves. The  employer  does  not  know  how 
to  protect  them  or  has  not  the  courage 
to  do  so.  Boards  of  Health  can  and 
should  do  it. 

Boards  of  Health  should  sterilize  houses, 
offices,  and  shops  which  have  been  occu- 
pied by  consumptives.  Innocent  parties 
coming  into  such  places  have  no  way  of 
protecting  themselves. 

When  a  place  which  has  been  occupied  by 
a  consumptive  has  been  sterilized,  the  fact 
should  be  so  recorded  in  an  open  record. 
This  would  enable  people  to  assure  them- 
selves that  places  into  which  they  are  about 
to  move  are  free  from  contamination. 

Boards  of  Health  should  also  sterilize 
the  belongings  of  consumptives  after  death 
before  they  can  fall  into  the  hands  of  inno- 
cent people.     Everything  which  has  been 


Governments  in  Prevention  265 

used  by  a  consumptive  should  be  sterilized 
before  it  is  allowed  to  be  used  by  any  one 
else. 

Well-meaning  people  often  give  the  per- 
sonal property  of  a  consumptive  to  the 
poor  in  order  that  it  may  not  be  wasted. 
Such  a  gift  often  carries  death  v/ith  it. 


CHAPTER  XLII 

How  to  Sterilize  Places  and 

Things  which  Have  Been 

Contaminated  by 

Consumptives 

TO  sterilize  a  thing  means  to  destroy  all  the 
life  that  is  in  it.  To  sterilize  places  and 
things  which  have  been  contaminated  by 
consumptives  means  to  remove  all  the  con- 
taminating matter  in  or  upon  them  or  to 
kill  the  micro-organisms  in  the  matter. 

The  contaminating  matter  in  consump- 
tion always  is  broken-down  tissue.  Some- 
times it  is  called  spit  or  sputum,  and 
sometimes  pus  or  matter.  Whatever  its 
name  or  whencesoever  it  comes,  it  always 
is  visible  in  the  beginning. 

When  it  has  become  finely  divided  up  in 
the  moist  or  dry  state,  however,  it  may 
escape  detection.     Small  particles  of  tuber- 

266 


Sterilization  of  Places  267 


cular  matter  in  food  or  small  particles  of 
tubercular  dust  on  a  floor  or  wall  cannot 
be  seen. 

Tubercular  matter  which  is  not  sterilized 
immediately  upon  being  given  off,  when  it 
easily  can  be  seen  and  controlled,  therefore 
becomes  very  troublesome  to  sterilize  when 
it  has  been  scattered  about.  It  is  so  diffi- 
cult to  know  where  it  has  gone  to  and  what 
it  may  have  contaminated. 

To  sterilize  a  place  which  has  been  con- 
taminated by  a  consumptive  is  no  small 
matter,  therefore.  It  means  either  removal 
of  every  particle  of  tubercular  matter  from 
the  place  or  killing  all  the  micro-organisms 
in  the  matter. 

Removal  of  every  particle  of  tubercular 
matter  involves  scraping  of  walls  and 
washing  them  down,  scrubbing  the  wood- 
work and  floors,  and  thoroughly  cleaning 
out  every  crevice  in  the  place.  When  a 
whole  house  has  to  be  done  in  this  manner 
it  is  an  expensive  procedure. 


268  Crusade  against  Tuberculosis 

Killing  the  micro-organisms  in  the  tuber- 
cular matter  in  a  place  is  not  easily  accom- 
plished. The  broken-down  tissue  acts  as  a 
cache  or  hull  for  the  tubercle  bacilli  and 
protects  them.  Germicides  cannot  easily 
get  at  them. 

The  ordinary  method  of  sterilizing  a 
room  with  sulphur  fumes  commonly  used 
after  certain  diseases  is  therefore  not  of 
much  value  in  tuberculosis.  The  fumes  do 
not  penetrate  the  tubercular  matter. 

Formaldehyde,  which  is  very  penetrating, 
sterilizes  tubercular  matter  when  such  mat- 
ter is  finely  divided  or  pulverized.  It  can- 
not be  depended  upon,  however,  for  coarse 
tubercular  matter. 

There  is  much  albumin  in  tubercular 
matter.  Sometimes  there  also  is  fibrin. 
These  substances  are  coagulated  and  hard- 
ened by  most  of  the  germicides. 

The  hardening  protects  the  tubercle 
bacilli  which  are  on  the  inside.  Matter 
which  has  been  acted  upon  by  such  germi- 


Sterilization  of  Places  269 


cides  often  is    preserved   instead   of  steril- 
ized. 

Corrosive  sublimate,  carbolic  acid,  and 
formalin  all  have  this  hardening  influence 
on  tubercular  matter.  They  are  not  of 
much  value,  therefore,  for  sterilizing  places 
and  things  which  have  been  contaminated 
by  consumptives. 

For  sterilizing  places  we  really  have  only 
one  reliable  method — namely,  scrubbing 
and  cleaning.  This  scrubbing,  moreover, 
must  be  done  with  soap  and  water  or  lye 
and  water,  and  not  with  germicides. 

Rooms  which  have  been  occupied  by 
consumptives  during  the  dying  period  of 
the  disease  should  be  thoroughly  scraped, 
scrubbed,  repainted,  and  repapered.  They 
should  be  renovated  in  every  part. 

Rooms  which  have  been  occupied  by 
consumptives  only  occasionally,  such  as 
sitting-rooms,  parlors,  and  perhaps  dining- 
rooms,  should  be  thoroughly  cleaned  and 


270         Crusade  agamst  Tuberculosis 

then  filled  with  formaldehyde.  Hallways 
need  merely  be  cleaned. 

In  sterilizing  with  formaldehyde  pains 
should  be  taken  to  close  all  openings  in  the 
room  and  to  fill  the  room  to  its  full 
capacity.  The  work  had  better  be  done 
by  an  expert. 

For  sterilizing  things  which  have  been 
contaminated  heat  should  be  used  when 
possible.  Heat  is  a  very  convenient  germi- 
cide for  the  tubercle  bacillus  because  a 
very  high  temperature  is  not  necessary  to 
kill  the  bacillus. 

Small  things  which  can  be  placed  in  the 
bake-oven  may  be  sterilized  at  home.  Only 
a  temperature  of  two  hundred  degrees  at 
most  is  necessary  to  kill  the  tubercle 
bacillus. 

Things  which  can  be  boiled  without 
injury  may  be  sterilized  by  boiling.  Bed- 
clothes and  much  of  the  wearing  apparel 
may  be  sterilized  in  this  way. 

Large  things  which  cannot  be  subjected 


Sterilization  of  Things  271 

to  dry  heat  at  home  and  cannot  be  boiled 
may  be  sent  to  a  sterilizing  plant,  if  there  is 
one  near  by.  In  all  large  cities  and  in 
many  towns  there  are  sterilizing  plants 
owned  by  the  government  and  operated  by 
the  Board  of  Health. 

Articles  which  cannot  be  subjected  to 
dry  heat  and  cannot  be  boiled  should  be 
carefully  cleaned.  If  they  permit  of  it, 
they  should  be  thoroughly  scrubbed  with 
soap  and  water.  Some  things  can  best  be 
cleaned  with  a  stiff  whisk  dipped  in  water. 

Whatever  is  done  for  the  purpose  of 
sterilizing  places  and  things  which  have 
been  contaminated  by  consumptives  must 
be  done  thoroughly.  Every  particle  of 
tubercular  matter  must  be  devitalized  or 
removed. 


CHAPTER  XLIII 

Dispensaries,  Hospitals, 

and  Sanatoria  for 

Consumptives 

AS  society  is  constituted  it  is  impracticable 
to  stamp  out  tuberculosis  by  education 
alone.  With  the  poor,  the  ignorant,  and 
the  vicious  education  is  not  sufficient 

Individual  measures  for  the  prevention 
of  tuberculosis,  for  execution,  require 
means,  intelligence,  and  good  disposition. 
Where  any  one  of  these  is  wanting,  the 
result  is  vitiated. 

Not  that  individual  preventive  measures 
are  expensive,  intricate,  and  burdensome  ; 
for  they  are  not.  At  most,  they  are  irk- 
some. But  they  do  cost  some  money, 
some  thought,  and  some  self-sacrifice. 

For  a  person  who  always  has  these  three 
things  to   spare  it  is  a  trifle  ;  for  a  person 

272 


Hospitals  and  Sanatoria  273 

who  is  always  deficient  in  them  it  is  a 
tax.  The  sick  poor  who  have  been  sick  a 
long  time  are  apt  to  be  short  on  all  three. 

A  poor  consumptive  seldom  can  get  the 
necessaries  of  life.  His  brain  is  badly- 
nourished  and  ill  fitted  for  thought.  His 
crippled  organism  struggles  for  self-preser- 
vation and  rebels  against  self-sacrifice. 

Who  can  blame  him  if  he  does  that 
which  appears  best  and  easiest  for  himself; 
if  he  uses  all  his  means,  thought,  and 
energy  to  save  his  worn  life  rather  than  to 
protect  others  ! 

In  the  early  stages  of  tuberculosis  a 
little  help  to  the  poor  often  would  be  all 
that  is  necessary  to  save  life.  Proper  food, 
a  little  good  advice,  and  perhaps  a  little 
medicine  would  turn  the  tide. 

This  aid  can  be  given  best  in  a  dispen- 
sary. It  must  not  be  an  ordinary  dispen- 
sary, however.  It  must  be  a  dispensary 
which  gives  food,  medicine,  spit  cups, 
paper  napkins,  and  paper  bags,  shows  how 

18 


2  74         Crusade  against  Tuberculosis 

to  use  them,  shows  how  to  ventilate  sleep- 
ing quarters — in  short,  regulates  life  for 
the  patient. 

With  this  assistance  the  patient  often  can 
go  on  with  his  occupation,  if  not  on  whole 
time,  at  least  on  part  time,  and  recover  his 
health.  When  he  has  recovered,  he  is  still 
in  harness  and  is  a  useful  citizen. 

When  the  disease  is  farther  advanced,  so 
as  to  make  rest  an  essential  factor  in  treat- 
ment, a  sanatorium  is  the  proper  place  for 
the  poor  consumptive.  Here  he  can  be 
brought  back  to  health  and  trained  to  habits 
and  methods  which  make  him  harmless  to 
others. 

In  a  sanatorium  the  treatment  begins 
with  almost  complete  rest  and  ends  with  a 
full  day's  work.  The  diet  is  carefully  regu- 
lated, medication  is  given  when  needed,  and 
the  patient  is  trained  to  a  life  of  moral  and 
physical  discipline. 

When  a  patient  goes  out  of  a  sanatorium 
restored  to  health,  he  goes  out  as  a  useful 


Hospitals  and  Sanatoria  275 

citizen.  He  knows  how  to  take  care  of  him- 
self and  is  able  to  teach  others  to  take  care 
of  themselves  and  to  protect  those  around 
them. 

Sanatoria  not  only  are  useful  in  saving 
life  directly,  but  in  saving  it  indirectly  by 
preventing  the  spread  of  the  disease. 
Every  case  which  they  take  out  of  the 
home  and  place  of  business  reduces  by  that 
much  the  source  of  seed-supply  for  new 
cases. 

Cases  which  are  advanced  beyond  the 
curable  stage  should  be  cared  for  in  hospi- 
tals. There  is  nothing  so  pitiable  in  human 
suffering  as  a  poor  consumptive  lying  upon  a 
hard  bench  in  a  kitchen  w^aiting  for  death. 

These  poor  creatures  often  have  no  one 
to  minister  to  their  wants  except  the  half- 
starved  woman  who  cooks,  scrubs,  and 
washes  for  the  family.  Perhaps  it  is  a 
mother,  perhaps  a  wife,  perhaps  a  sister, 
perhaps  a  daughter. 

The  kitchen  serves  as  sick-room,  sitting- 


276         Crusade  against  Tuberculosis 

room,  and  dining-room  as  well  as  kitchen 
among  the  poor.  It  is  the  place  where  the 
whole  family  lives  when  not  employed  or 
asleep. 

The  poor  dying  consumptive  usually  lies 
upon  a  bunk  in  this  room  and  spits  into  the 
coal  scuttle,  into  the  stove,  or  upon  the 
floor.  The  whole  room  is  contaminated, 
and  the  food  which  is  prepared  and  eaten 
in  it  can  hardly  fail  to  be  mixed  with  tuber- 
cular matter. 

To  live  in  a  house  with  a  dying  consump- 
tive under  these  circumstances  is  tantamount 
to  getting  an  implantation  of  tuberculosis. 
Every  member  of  the  family  gets  an  im- 
plantation. Usually  the  entire  family  dies 
with  the  disease,  slowly  but  surely,  one 
after  another. 

If  any  escape,  it  is  because  they  develop 
an  immunity  and  recover.  Sometimes  the 
disease  leaves  those  who  escape  crippled  or 
invalided. 

The  establishment  of  dispensaries,  sana- 


Hospitals  and  Sanatoria  277 

toria,  and  hospitals  for  the  treatment  of  the 
consumptive  poor  will  have  to  be  the  chief 
weapon  for  beating  out  the  great  conflagra- 
tion tuberculosis.  It  is  the  most  efficient 
and  the  most  humane  method  of  dealing 
with  the  disease. 

What  golden  fruit  for  the  wealthy  phil- 
anthropist! He  needs  but  pluck  it  to  be 
crowned  with  immortality.  The  name  which 
goes  down  to  posterity  coupled  with  the 
stamping  out  of  tuberculosis  will  live  for- 
ever. 

Governments,  too,  should  do  all  in  their 
power  to  establish  such  institutions.  Every 
city  should  have  dispensaries  and  hospitals, 
and  every  State  should  have  sanatoria. 

Governments  owe  it  to  their  citizens  to 
establish  such  institutions.  They  owe  it  to 
the  sick  and  to  the  well.  Now  that  tuber- 
culosis is  known  to  be  a  preventable  disease, 
it  is  the  duty  of  governments  to  prevent  it. 


CHAPTER  XLIV 

How   to   Avoid   Get- 
ting Consumption 

AS  YET  governments  are  not  doing  much 
for  the  protection  of  the  individual  against 
consumption.  It  therefore  behooves  the 
individual  to  inform  himself  about  what  to 
do  to  protect  himself. 

The  consumptive  will  not  take  the  initia- 
tive in  the  prevention  of  tuberculosis.  It  is 
not  to  be  expected  of  him.  He  follows 
the  promptings  of  nature  in  trying  to  save 
himself,  disregardful  of  the  interests  of 
others. 

The  disease  makes  him  selfish.  It  is 
nature's  way  of  trying  to  save  him.  But 
besides  the  promptings  of  nature,  he  has 
reason  for  being  selfish  in  that  he  is  out- 
lawed to  humanity  and  human  fellowship. 

278 


Avoidance  of  Consumption  279 


It  is  too  much  to  ask  the  consumptive 
to  bear  the  entire  burden  of  protection  to 
others.  They  who  ask  protection  at  least 
should  be  willing  to  take  part  of  the  bur- 
den.    In  fairness  they  should  assume  it  all. 

If  a  consumptive  is  to  give  up  his  occu- 
pation for  the  protection  of  others,  he 
should  be  supported  at  the  expense  of  those 
who  are  protected.  If  he  is  to  keep  away 
from  those  who  are  well,  he  should  be 
given  some  place  to  go.  If  he  is  to  use 
certain  things  for  the  protection  of  others, 
he  should  be  supplied  with  the  money  to 
buy  them  with. 

It  is  not  fair  to  say  to  the  consumptive  : 
"  I  want  you  to  get  out  of  your  way  of 
living  because  you  endanger  my  life  ;  I 
want  you  to  go  away  from  me  because  I 
may  get  your  disease  ;  I  want  you  to  buy 
this  and  that  thing  and  use  it  so  that  I  may 
be  protected." 

Better  to  say  to  him  :  "  Brother,  you 
have   a  loathsome   disease  which   I   don't 


28o  Crusade  against  Tuberculosis 

want  to  get.  Stop  work,  go  to  a  sanato- 
rium or  hospital,  and  get  well  if  possible ; 
and  \{  not  possible,  at  least  be  comforta- 
ble. I  am  well.  Let  me  provide  for  you 
in  return  for  the  protection  which  you  give 
me. 

"If  you  must  work  and  continue  in  the 
bosom  of  your  family,  let  me  show  you 
how  you  can  make  yourself  harmless  to 
them  and  to  me.  I  will  buy  you  all  you 
need  to  do  this  with  and  show  you  what 
to  do  and  how  to  do  it." 

Could  we  who  are  well  all  agree  to  act 
thus  toward  our  stricken  brethren,  how 
completely  we  could  protect  ourselves  and 
how  light  would  be  the  burden !  It  would 
scarcely  cost  us  two  dollars  apiece  the  world 
over  to  vripe  out  consumption. 

It  is  impracticable  for  us,  however,  to  be 
united  in  this  work.  Too  many  of  us 
would  like  to  get  the  benefit  without  the 
burden.  We  are  unwilling  to  contribute 
our  mite. 


Avoidance  of  Consumption  281 

Until  we  come  together  and  through  our 
governments  provide  for  the  consumptive 
in  a  way  that  will  protect  us,  there  is 
nothing  left  for  us  but  for  each  of  us  to  pro- 
tect himself  the  best  he  can.  To  some  ex- 
tent this  is  possible. 

Individual  protection  can  best  be  secured 
by  kind  attention  to  those  consumptives 
with  whom  one  must  come  in  contact. 
There  is  no  danger  from  the  consumptive 
whom  one  can  see  and  control. 

While  the  consumptive  will  not  take  the 
initiative  in  preventive  measures,  he  will  co- 
operate. If  told  what  to  do  to  protect 
others  and  helped  to  do  it,  he  will  try. 
With  patient  effort  usually  he  can  be  made 
to  do  all  that  is  necessary. 

For  self-protection  the  healthy  individual, 
therefore,  should  kindly  and  patiently  insist 
that  every  consumptive  with  whom  he  comes 
in  continuous  contact  shall  sterilize  all  tuber- 
cular matter  the  moment  it  is  given  off  If 
necessary,  he  should  supply  him  with  the 


282  Crusade  against  Tuberculosis 

necessary  articles  for  this  purpose  and  show 
him  how  to  use  them. 

One  should  not  live  in  the  same  room 
with  a  consumptive  unless  the  consumptive 
does  sterilize  all  tubercular  matter  the 
moment  it  is  given  off.  Better  to  move  at 
any  sacrifice  than  to  do  so.  If  all  matter 
is  sterilized  at  once,  there  is  no  danger. 

One  should  not  use  the  eating  or  drink- 
ing utensils  of  a  consumptive  without  first 
carefully  scalding  them,  or  at  least  washing 
them  with  soap  and  water.  Mere  rinsing 
with  cold  water  is  not  sufficient. 

When  one  receives  anything  which  has 
been  used  by  a  consumptive,  it  is  well  to 
cleanse  or  sterilize  it  before  using  it.  If  it 
is  something  which  can  be  washed,  it  may 
be  washed  with  soap  and  water.  If  it  can- 
not be  washed,  it  had  better  be  sterilized  by 
high  temperature. 

One  should  not  shake  hands  with  con- 
sumptives nor  kiss  them  on  the  mouth. 
Handshaking  and  kissing  outside  of  one's 


Avoidance  of  Consumption  283 

immediate  family  are  customs  anyhow  which 
are  better  honored  in  the  breach  than  in 
the  performance.  They  are  a  handy  way 
of  swapping  diseases. 

When  one  has  to  change  his  place  of 
abode,  he  should  take  some  trouble  to  in- 
quire into  the  previous  history  of  the  room, 
office,  shop,  or  house  into  which  he  is  go- 
ing to  move.  If  it  has  been  occupied  by  a 
consumptive,  it  is  as  well  not  to  move  in 
until  it  has  been  sterilized. 

For  protection  against  casual  exposure 
to  consumption  all  that  is  necessary  is 
cleanliness  in  personal  habits.  One  should 
always  wash  the  hands  and  face  before  eat- 
ing, and  one  should  not  eat,  drink,  nor 
smoke  while  in  a  tubercular  environment. 
One  should  also  avoid  putting  things  into 
the  mouth  which  do  not  belong  there,  and 
picking  the  nose. 

Good  health  enables  one  to  withstand 
implantation  of  tubercle  bacilli  within  cer- 
tain limits.  For  protection  against  casual 
exposure  it  probably  always  is  sufficient. 


284        Crusade  against  Tuberculosis 

Even  people  in  good  health,  however, 
sometimes  weaken  their  disease-fighting 
powers  by  dissipation  and  excesses.  During 
such  a  period  of  depression  implantation 
may  take  place  if  there  is  proper  exposure. 

One  therefore  always  should  maintain  a 
normal  standard  of  health  and  avoid  de- 
pression. The  body  should  be  kept  up  to  a 
strictly  physiological  standard  in  the  per- 
formance of  all  of  its  functions.  Anything 
that  may  congest,  inflame,  or  cripple  an 
organ  should  be  avoided. 

Dampness,  darkness,  bad  ventilation,  and 
bad  drainage  should  be  carefully  avoided  in 
the  place  of  abode,  business,  or  occupation. 
They  all  are  predisposing  causes  of  tuber- 
culosis, and,  like  the  dust  on  the  weight  in 
a  delicately  balanced  scale,  may  be  the  de- 
termining factors  of  a  person's  getting  tuber- 
culosis. 

One's  bedroom  always  should  be  well 
ventilated  and  well  sunned.  Did  those  who 
are  well  live  more  in  the  fresh  air  and  sun- 


Avoidance  of  Consumption  285 

light,  there  would  be  fewer  consumptives  to 
take  fresh-air  treatment  for  their  recovery. 
What  helps  to  cure  also  helps  to  keep  well. 
Care  also  should  be  exercised  in  diet. 
Many  people  predispose  themselves  to  con- 
sumption by  breaking  down  their  digestive 
systems  with  unhealthful  food  or  stimulants. 
A  plain  substantial  diet  should  be  used,  and 
not  one  which  tickles  the  palate. 


CHAPTER  XLV 

Should  Consumptives 
Marry? 

SOME  men,  in  their  zeal  to  save  human 
life,  recently  have  ridden  the  false  theory 
of  heredity  of  consumption  so  far  as  to 
want  to  forbid  by  law  marriage  to  all  con- 
sumptives. The  enactment  of  such  a  law 
would  be  utterly  unwarranted. 

Consumption  is  not  inherited.  On  the 
contrary,  immunity  gradually  comes  to 
those  in  whose  ancestry  the  disease  has  ex- 
isted. 

What  immunity  the  white  race  enjoys 
has  come  to  it  through  heredity.  It  is  to 
children  of  consumptive  parents  that  we 
owe  the  protection  we  now  possess. 

Life,  therefore,  would  not  be  saved  by 
prohibition  of  marriage  between  consump- 
tives.      On   the    contrary,  the    conserving 

286 


Should  Consumptives  Marry?      287 

power  of  nature  would  be  handicapped  in 
its  operation.  ^ 

Besides,  prohibition  of  marriage  would 
not  prevent  consumptives  from  having  off- 
spring. Unnatural  laws  always  defeat 
themselves. 

It  merely  would  put  burdens  upon  the 
children  of  consumptives  to  cripple  them  in 
their  struggle  for  existence.  It  would  de- 
stroy life  instead  of  saving  it. 

There  is  no  good  reason  why  consump- 
tives should  not  marry,  so  far  as  the  off- 
spring is  concerned.  There  is  good  reason, 
however,  why  they  should  not  marry  on 
their  own  account. 

Celibacy  is  conducive  to  recovery  from 
consumption,  while  married  life  may  be  an 
impediment.  It  is  only  the  celibate  who 
can  devote  all  his  energy,  thought,  and  re- 
sources to  one  cause — that  of  getting  well. 

To  the  woman  marriage  brings  the  bur- 
dens of  motherhood,  which  often  have  a 
peculiarly  quickening  influence  on  tubercu- 


288         Crusade  against  Tuberculosis 

losis.  Many  a  young  consumptive  mother 
gets  her  shroud  shortly  after  she  has 
purchased  the  christening  frock  for  her 
babe. 

To  the  man,  too,  the  duties  of  married 
hfe  are  a  serious  impediment  to  recovery. 
Many  a  young  man  has  sacrificed  his 
chances  of  recovery  on  the  ahar  of  Hymen. 

There  are  times,  conditions,  and  circum- 
stances, however,  when  marriage  lessens 
the  burdens  of  life.  What  is  gained  in  this 
way  may  more  than  counterbalance  what  is 
risked  in  the  married  state. 

It  then  is  necessary  to  consider  carefully 
both  sides  and  choose  that  which  offers  the 
best  chance  of  recovery.  If  the  marriage 
state  is  entered  upon,  however,  it  should  be 
understood  by  both  parties  that  everything 
must  be  subservient  to  the  recovery  of  the 
stricken  one. 

The  fact  that  tuberculosis  is  contagious 
should  not  be  lost  sight  of  in  considering 
the    question    of  marriage.      The    healthy 


Should  Consumptives  Marry?      289 

party  to  the  marriage  contract  runs  some 
risk  of  getting  the  disease. 

The  relationship  between  husband  and 
wife  is  so  intimate  that  even  with  great  care 
there  may  be  given  opportunity  in  moments 
of  forgetfulness  for  conveyance  of  the  dis- 
ease. Husband  and  wife,  indeed,  frequently 
contract  the  disease  from  one  another. 

A  consumptive,  therefore,  should  care- 
fully consider,  before  marrying,  whether  he 
is  willing  to  expose  the  person  whom  he  is 
about  to  marry  to  the  danger  of  getting  his 
disease.  As  a  matter  of  honor,  he  should 
inform  the  party  of  his  ailment  and  of  the 
danger  from  it. 

A  person  considering  the  question  of 
marrying  a  consumptive  should  carefully 
weigh  the  risk  and  the  burdens  which  he  is 
assuming.  Unless  he  can  go  into  the  mat- 
ter in  a  spirit  of  self-sacrifice,  he  should  not 
take  the  step. 

Even  when  the  consumptive  has  re- 
covered his  physical  health  there  may  be 

19 


290         Crusade  against  Tuberculosis 

danger  to  the  person  whom  he  marries.  He 
still  may  be  giving  off  tubercle  bacilli. 

There  are  many  cases  on  record  where 
men  and  women  have  given  the  disease  to 
two  or  three  consorts  in  succession  without 
themselves  going  under.  In  such  cases 
there  is  fair  health,  but  never  complete  re- 
covery. 

Then,  too,  the  dormant  disease  may 
again  break  out  after  marriage.  The  bur- 
dens and  responsibilities  of  married  life  may 
sufficiently  depress  the  system  to  enable 
the  disease  again  to  get  a  start. 

A  healthy  person  about  to  marry  a  con- 
sumptive should  have  all  these  things  be- 
fore him.  If  he  is  willing  to  take  all  the 
chances,  to  carry  the  burdens,  and  to  make 
the  necessary  sacrifice  for  the  person  whom 
he  is  about  to  marry,  no  one  should  have  a 
right  to  interfere. 


CHAPTER  XLVI 

Should  a  Consumptive 

Mother  Suckle 

Her  Child? 

EVERYWHERE  nature's  laws  conspire 
to  preserve  the  offspring.  On  all  sides  we 
see  her  beautiful  solicitude  for  the  young 
and  helpless. 

When  disease  strikes  the  mother  during 
the  period  of  total  dependence  of  the  child, 
it  rarely  hits  the  child.  As  a  rule,  the 
child  comes  into  the  world  healthy  and 
well  nourished. 

The  child  of  a  consumptive  mother 
nearly  always  is  born  healthy.  In  excep- 
tional cases  the  disease  has  extended  to  the 
child  by  contagion,  but  in  exceptional 
cases  only. 

After  birth  the  child  of  a  consumptive 
mother  is  beset  with  danger.     It  constantly 

291 


292         Crusade  against  Tuberculosis 

is  exposed  to  contagion.  Its  natural  custo- 
dian is  sick,  perhaps  mentally  as  well  as 
physically. 

Its  natural  source  of  food-supply  is 
under  an  embargo.  The  machinery  which 
produces  the  food  is  crippled.  The  food 
itself  may  be  poisoned  at  the  fountain-head. 

What  is  to  be  done  for  the  best  interests 
of  the  child  under  such  circumstances  ?  Is 
it  to  be  suckled  by  its  mother  ? 

This  is  a  question  of  great  import.  The 
answer  depends  upon  many  conditions  and 
circumstances. 

The  agriculturist  has  had  to  meet  the 
same  issue  with  cattle.  His  decision  may 
be  accepted  as  correct,  because  it  is  based 
upon  a  commercial  test.  He  removes  the 
offspring  from  the  mother. 

When  it  is  possible  to  do  so,  the  child 
should  be  given  a  healthy  wet-nurse.  If 
this  is  done,  the  child  may  be  kept  near  the 
mother,  but  must  be  protected  against 
contagion. 


Mother  and  Child  293 

When  a  wet-nurse  cannot  be  had,  the 
next  best  thing  to  do  is  to  remove  the  child 
from  the  mother  and  feed  it  on  cow's  milk. 
Under  these  circumstances  the  child  should 
be  as  little  in  contact  with  the  mother  as 
possible  and  never  should  be  fed  by  her. 

If  the  child  must  be  with  the  mother 
and  cared  for  by  her,  it  best  had  be 
suckled  by  her.  There  is  much  less  danger 
to  the  child  in  this  than  in  artificial  feeding. 

The  milk  of  a  tubercular  mother  prob- 
ably has  some  immunizing  qualities.  If  so, 
the  child  may  imbibe  sufficient  immunity 
with  its  milk  to  enable  it  to  withstand 
small  doses  of  tubercle  bacilli. 

The  mother's  milk,  moreover,  will  keep 
the  child  in  better  condition  of  health  than 
would  artificial  feeding.  There  is  less 
danger  of  indigestion  and  irritation  to  the 
alimentary  canal  from  it  than  from  artificial 
food. 

Artificial  feeding  often  becomes  a  predis- 
posing cause   of  consumption  in   children 


294         Crusade  against  Tube^'cidosis 

by  the  irritation  which  it  sets  up  and  the 
malnutrition  which  it  leads  to.  Bottle-fed 
babies  often  are  victims  of  tuberculosis. 

There  is  less  danger  of  tubercle  bacilli 
getting  into  the  system  of  the  infant 
through  suckling  than  through  artificial 
feeding.  The  handling  of  implements  for 
feeding  by  the  consumptiv^e  mother  con- 
taminates them. 

It  is  quite  natural  for  the  mother  to  taste 
her  baby's  food  to  make  sure  that  it  is  all 
right.  In  doing  so  she  is  apt  to  contami- 
nate the  nipple  or  spoon  with  which  she 
feeds. 

On  the  mother's  side  there  is  some  reason, 
of  course,  why  she  should  not  nurse  her 
child.  She  needs  all  the  energy  she  can 
make  for  her  own  recovery,  and  cannot 
well  spare  any  for  her  child. 

It  may  be  possible,  however,  for  her  to 
increase  her  food  sufficiently  to  make  up 
for  what  she  gives  to  the  child.  If  she  will 
add  from  one  quart  to  three  pints  of  milk 


Mother  and  Child  295 

a  day  to  her  diet,  she  will  make  up 
for  it. 

A  woman's  capacity  for  digesting  food 
usually  increases  during  lactation.  In  a 
way,  this  increased  capacity  for  digesting 
food  may  redound  to  her  own   benefit. 

At  any  rate,  experience  shows  that  no 
injury  comes  to  a  consumptive  mother  from 
nursing  her  child  if  she  gets  enough  of 
the  right  kind  of  food.  A  consumptive 
mother  suckling  her  child  should  drink 
from  four  to  five  quarts  of  milk  a  day. 

Considering  the  welfare  of  both  mother 
and  child,  probably  the  safest  rule  to 
follow  when  the  child  cannot  be  put 
away  from  the  mother  is  to  suckle  the 
child  until  it  is  strong  enough  to  thrive 
well  on  cow's  milk.  Then  the  child 
should  be  weaned  and  fed  by  some  one 
else  than  the  mother. 


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